Laoire Áine Ní, Murtagh Fliss E M
Milford Care Centre, Castletroy, Limerick, Ireland.
Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
BMJ Support Palliat Care. 2018 Dec;8(4):400-410. doi: 10.1136/bmjspcare-2017-001359. Epub 2017 Aug 23.
Critical limb ischaemia (CLI) is a severe manifestation of peripheral arterial disease, characterised by chronic ischaemic rest pain, ulcers or gangrene. Management of ischaemic pain is challenging in patients with no options for revascularisation and optimal pharmacological therapies have not been established.
To identify and evaluate the effectiveness of pharmacological therapies to treat ischaemic pain secondary to non-reconstructable CLI.
This systematic review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Comprehensive searches of three electronic databases, a PubMed-related articles link search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were performed. Studies recruiting adult patients with CLI of any aetiology were eligible for inclusion. Surgical and revascularisation procedures, and all invasive interventions were excluded.
Of 792 studies, six met full inclusion criteria. These studies researched the use of intravenous lidocaine, intravenous ketamine, oral gabapentin and the combination of transdermal buprenorphine and epidural morphine/ropivacaine infusion. All studies showed an improvement in severity of ischaemic pain in CLI but with varying side effect profiles and quality. The extracted studies showed substantial heterogeneity and therefore a meta-analysis was not performed.
The pharmacological management of pain secondary to non-reconstructable CLI is a challenging review topic. No recommendations of pharmacological agents can be made following this review but a number of novel approaches to manage pain in this cohort have shown positive results and require further investigation.
严重肢体缺血（CLI）是外周动脉疾病的一种严重表现，其特征为慢性缺血性静息痛、溃疡或坏疽。对于没有血管重建选择的患者，缺血性疼痛的管理具有挑战性，并且尚未确立最佳的药物治疗方法。
识别并评估用于治疗不可重建性CLI继发缺血性疼痛的药物治疗的有效性。
本系统评价按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行报告。对三个电子数据库进行了全面检索、PubMed相关文章链接检索、灰色文献检索，并对手检相关论文和教科书的参考文献进行了检索。纳入招募任何病因的成年CLI患者的研究。排除手术和血管重建程序以及所有侵入性干预措施。
在792项研究中，六项符合完全纳入标准。这些研究探讨了静脉注射利多卡因、静脉注射氯胺酮、口服加巴喷丁以及透皮丁丙诺啡与硬膜外吗啡/罗哌卡因输注联合使用的情况。所有研究均显示CLI患者缺血性疼痛的严重程度有所改善，但副作用情况和质量各不相同。所提取的研究显示出很大的异质性，因此未进行Meta分析。
不可重建性CLI继发疼痛的药物管理是一个具有挑战性的综述主题。本次综述后无法给出药物治疗建议，但一些针对该队列疼痛管理的新方法已显示出积极结果，需要进一步研究。
