标题：胸椎旁阻滞用于乳腺手术麻醉的安全性及有效性的Meta分析

      作者：唐家喜 1,2，何永鹏 2，刘红亮 2，王玲 2，辇伟奇 2    (1.广西医科大学研究生学院，广西 南宁 530021；2.重庆大学附属肿瘤医院/重庆市肿瘤研究所/重庆市肿瘤医院，重庆 400030)

      卷次： 2018年29卷7期

      【摘要】 目的 系统评价胸椎旁阻滞麻醉在乳腺手术中应用的安全性及有效性。方法 计算机全面检索PubMed、The Cochrane Library、Embase、springer、WanFang data、VIP和 CNKI数据库，查找关于胸椎旁阻滞用于乳腺手术麻醉的随机对照试验(RCT)，检索时限均从建库至 2016年 12月。由 2位评价员按纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后，采用 RevMan 5.1软件进行Meta分析。结果 共纳入7个研究，424例患者。Meta分析结果显示：与全身麻醉组相比，胸椎旁阻滞麻醉组用于乳腺手术阻滞成功率差异无统计学意义[RR=0.98，95%CI (0.95，1.01)，P=0.20]；术中芬太尼用量较少[MD=-43.03，95%CI (-53.31，-32.76)，P<0.000 01]；术后吗啡用量较少[MD=-3.80，95%CI (-6.10，-1.50)，P=0.001]；住院时间较短[SMD=-1.22，95%CI (-1.71，-0.73)，P<0.000 01]；PONV发生率较低[RR=0.33，95%CI (0.15，0.72)，P=0.005]；患者满意度较高[SMD=0.80，95%CI (0.36，1.24)，P<0.000 4]。结论 与全身麻醉比较，胸椎旁阻滞麻醉能有效用于乳腺手术，减少术中、术后镇痛药物使用，缩短住院时间，降低术后恶心、呕吐发生率，提高患者满意度。
      【关键词】 胸椎旁阻滞；乳腺手术；Meta分析
      【中图分类号】 R655.8 【文献标识码】 A 【文章编号】 1003—6350（2018）07—1024—05

Efficacy and safety of thoracic paravertebral block for anesthesia in breast surgery: a meta-analysis.
TANGJia-xi 1,2, HE Yong-peng 2, LIU Hong-liang 2, WANG Ling 2, NIAN Wei-qi 2. 1. Graduate College, Guangxi MedicalUniversity, Nanning 530021, Guangxi, CHINA; 2. Chongqing Cancer Institute/Hospital/Cancer Center, Chongqing 400030,CHINA
【Abstract】 Objective To systematically evaluate the efficacy and safety of thoracic paravertebral block for an-esthesia in breast surgery. Methods The randomized controlled trials (RCTs) about thoracic paravertebral block for an-esthesia in breast surgery in databases, including PubMed, The Cochrane Library, Embase, Springer, WanFang data, VIPand CNKI, were searched from their inception to December 2016. Two reviewers screened literature according to the in-clusion and exclusion criteria, extracted data and assessed the methodological quality of included studies, and then me-ta-analysis was performed by using RevMan 5.1 software. Results A total of 7 RCTs involving 424 patients were in-cluded. The results of meta-analysis showed that: compared with general anesthesia group, paravertebral block for anes-thesia in breast surgery had similar success rate (RR=0.98, 95%CI [0.95,1.01], P=0.20), less intraoperative fentanyl con-sumption (MD=-43.03, 95% CI [-53.31, -32.76], P<0.000 01), less postoperative morphine consumption (MD=-3.80,95%CI [-6.10, -1.50], P=0.001), significantly shorter hospital stay (SMD=-1.22, 95%CI [-1.71, -0.73], P<0.000 01),lower incidence of PONV (RR=0.33, 95%CI [0.15, 0.72], P=0.005), and higher patient satisfaction (SMD=0.80, 95%CI[0.36,1.24], P<0.000 4). Conclusion Compared with general anesthesia, thoracic paravertebral block for anesthesia iseffective for breast surgery, which can reduce the use of analgesics during operation and postoperative analgesics, short-en hospitalization time, decrease the incidence of postoperative nausea and vomiting, and improve patient satisfaction.
      【Key words】 Thoracic paravertebral block; Breast surgery; Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2018.07.045