George Jessica A, Lin Elaina E, Hanna Marie N, Murphy Jamie D, Kumar Kanupriya, Ko Phebe S, Wu Christopher L
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA.
J Opioid Manag. 2010 Jan-Feb;6(1):47-54. doi: 10.5055/jom.2010.0004.
Although the addition of a background infusion for intravenous patient-controlled analgesia (IV-PCA) has been identified as a risk factor for the development of respiratory depression, this has not clearly been examined in a systematic fashion. The authors undertook a systematic review and meta-analysis of available randomized controlled trials (RCTs) to examine whether the addition of a background or continuous infusion to an IV-PCA regimen would be associated with an increased risk of respiratory depression.
Studies were identified by searching the National Library of Medicine's PubMed database (1966 to November 30, 2008). Inclusion criteria were a clearly defined analgesic technique of demand-only IV-PCA versus IV-PCA utilizing both a demand dose and background infusion, opioid medication used, and randomized trials. Data were abstracted and analyzed with the RevMan 4.2.7 (The Cochrane Collaboration, 2004).
The search yielded 687 abstracts from which the original articles were obtained and data abstracted with a total of 14 articles analyzed. There were 402 subjects in the continuous IV-PCA with demand group versus the 394 subjects in the demand-only IV-PCA group. Addition of a background infusion to the demand dose for IV-PCA with opioids was associated with a significant increased risk for respiratory depression (odds ratio [OR] = 4.68, 95% confidence interval [CI]: 1.20-18.21). Subgroup analysis revealed that this increased risk was seen in adult but not in pediatric patients.
Our meta-analysis indicates that the addition of a continuous or background infusion to the demand dose for IV-PCA is associated with a higher incidence of respiratory events than demand IV-PCA alone in adult but not in pediatric patients; however, our overall results should be interpreted with caution due to the relatively small sample size and the wide range of definitions for respiratory depression in studies examined.
尽管静脉自控镇痛（IV-PCA）中添加背景输注已被确定为呼吸抑制发生的一个危险因素，但尚未以系统的方式对此进行明确研究。作者对现有的随机对照试验（RCT）进行了系统评价和荟萃分析，以研究在IV-PCA方案中添加背景或持续输注是否会增加呼吸抑制的风险。
通过检索美国国立医学图书馆的PubMed数据库（1966年至2008年11月30日）来识别研究。纳入标准为明确界定的单纯按需IV-PCA镇痛技术与同时使用按需剂量和背景输注的IV-PCA、使用的阿片类药物以及随机试验。使用RevMan 4.2.7（Cochrane协作网，2004年）对数据进行提取和分析。
检索得到687篇摘要，从中获取原始文章并提取数据，共分析了14篇文章。持续按需IV-PCA组有402名受试者，而单纯按需IV-PCA组有394名受试者。在按需剂量的阿片类药物IV-PCA中添加背景输注与呼吸抑制风险显著增加相关（优势比[OR]=4.68，95%置信区间[CI]：1.20 - 18.21）。亚组分析显示，这种风险增加在成年患者中可见，而在儿科患者中未见。
我们的荟萃分析表明，在成年患者中，在按需剂量的IV-PCA中添加持续或背景输注比单纯按需IV-PCA的呼吸事件发生率更高，但在儿科患者中并非如此；然而，由于样本量相对较小以及所研究的研究中呼吸抑制的定义范围广泛，我们的总体结果应谨慎解释。
