[关键词]
[摘要]
目的 系统评价塞来昔布联用阿片类药物(吗啡、羟考酮)治疗中重度癌性疼痛的临床疗效和安全性。方法 检索Cochrane Library、PubMed、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、维普中文期刊全文数据库(VIP)和万方数据库关于塞来昔布联用阿片药物对比单用阿片类药物治疗中重度癌性疼痛的随机对照试验(RCTs),检索时间为2000年1月—2019年7月。由2名研究者独立提取数据、评价质量,并交叉核对。采用RevMan 5.3软件进行Meta-分析。结果 共纳入12项RCTs,1 292例患者。Meta-分析结果显示相对于单用阿片,塞来昔布联用阿片药物能显著提高疼痛缓解率(OR=1.94,95%CI=1.64~2.59)、减少日均阿片药物用量(MD=-10.64,95%CI=-15.03~-6.26)和提高生活质量(MD=3.53,95%CI=1.34~5.72),差异均有统计学意义(P<0.01),按照阿片药物类别进行亚组分析结果与上述Meta-分析结果一致。在安全性方面,塞来昔布能显著降低吗啡便秘、恶心呕吐、嗜睡、头痛头晕发生率和羟考酮便秘发生率(P<0.01),对阿片药物致排尿困难发生率无影响。结论 塞来昔布联用阿片药物用于中重度癌痛患者镇痛疗效确切,同时可显著降低便秘和恶心呕吐等发生率。
[Key word]
[Abstract]
Objective To systematically evaluate the clinical efficacy and safety of celecoxib combined with opioid drugs (morphine, oxycodone) for the treatment of moderate to severe cancer pain. Methods Databases including Cochrane Library, PubMed, CBM, CNKI, VIP and Wanfang Database were searched to collect randomized controlled trials (RCTs) about celecoxib combined with opioid drugs combined vs opioid drugs alone for moderate to severe cancer pain from January 2000 to July 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of 12 RCTs, 1 292 patients were included. Meta-analysis showed that, compared with opioid drugs alone, celecoxib combined with opioid drugs could significantly improve the rate of pain relief (OR=1.94, 95%CI=1.64~2.59), reduce the daily average opioid dosage (MD=-10.64, 95%CI=-15.03~-6.26) and improve the quality of life (MD=3.53, 95%CI=1.34~5.72), the difference were statistically significant (P<0.01), Sub-group analysis by opioid category were consistent with Meta-analysis. In terms of safety, celecoxib significantly reduced the incidence of morphine in constipation, nausea and vomiting, drowsiness, headache and dizziness, and oxycodone constipation (P<0.01), but had no effect on the incidence of dysuria caused by opiates drugs. The funnel plot suggested that the publication bias was small. Conclusion Celecoxib combined with opioid drugs are effective for patients with moderate to severe cancer pain, and can significantly reduce the incidence of constipation, nausea and vomiting.
[中图分类号]
R971;R979.1
[基金项目]
黄石市医药卫生科研项目(2015-47)