肺移植中的冷冻镇痛——一项系统评价与荟萃分析

Cryoanalgesia in Lung Transplantation - A Systematic Review and Meta-analysis.

作者信息

Passos Felipe S, Bregion Pedro B, Oliveira Rachid E, Siemeni Thierry, Treml Ricardo E, Pessoa Bernardo M, Kirov Hristo, Doenst Torsten, Keshavjee Shaf, Caldonazo Tulio

机构信息

Department of Thoracic Surgery, INCAR Hospital, Santo Antônio de Jesus, Brazil.

State University of Campinas, São Paulo, Brazil.

出版信息

JHLT Open. 2025 Apr 8;8:100263. doi: 10.1016/j.jhlto.2025.100263. eCollection 2025 May.

DOI:10.1016/j.jhlto.2025.100263

PMID:40292042

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12022505/

Abstract

BACKGROUND

Lung transplantation is a crucial treatment for end-stage lung diseases. However, postoperative pain management remains a significant challenge. Therefore, this study aims to examine the implications of adoption cryoanalgesia on lung transplantation pain control protocol.

METHODS

Three databases were searched for studies comparing cryoanalgesia versus standard of care analgesia in patients after lung transplantation. The primary outcome was opioid consumption throughout the entire hospitalization, at postoperative day (POD) 7 and at POD 14 addressed with Morphine Milligram Equivalents (MME). The secondary outcomes were maximum reported pain score at POD 7, hospital length of stay (LOS) and time until extubation. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous outcomes.

RESULTS

A total of 5 studies encompassing 485 patients undergoing lung transplantation were included, of whom 228 underwent cryoanalgesia. Compared to standard of care, cryoanalgesia demonstrated significant reduction in opioid consumption at POD 7 (MD: -96.79 MME, 95% CI -183.40 to -10.18, p=0.03), at POD 14 (MD -225,26 MME; 95% CI -366.58 to -83.94; p<0.01) and throughout the entire hospitalization (MD: -307.76 MME, 95% CI -461.72 to -153.79, p<0.01). In addition, there was a significant reduction in pain scores in the cryoanalgesia group (MD: -1.10 points, 95% CI -1.77 to -0.43, p<0.01). However, no significant differences were found regarding hospital LOS or time until extubation.

CONCLUSIONS

This meta-analysis indicates that cryoanalgesia effectively reduces opioid requirements and pain levels in lung transplant patients.

摘要

背景

肺移植是终末期肺部疾病的关键治疗方法。然而，术后疼痛管理仍然是一项重大挑战。因此，本研究旨在探讨采用冷冻镇痛对肺移植疼痛控制方案的影响。

方法

检索了三个数据库，以查找比较肺移植患者冷冻镇痛与标准护理镇痛的研究。主要结局是整个住院期间、术后第7天（POD 7）和术后第14天（POD 14）使用吗啡毫克当量（MME）表示的阿片类药物消耗量。次要结局是POD 7时报告的最大疼痛评分、住院时间（LOS）和拔管时间。对连续结局计算95%置信区间（CI）的平均差异（MD）。

结果

共纳入5项研究，涉及485例接受肺移植的患者，其中228例接受了冷冻镇痛。与标准护理相比，冷冻镇痛在POD 7时阿片类药物消耗量显著降低（MD：-96.79 MME，95% CI -183.40至-10.18，p = 0.03），在POD 14时（MD -225.26 MME；95% CI -366.58至-83.94；p < 0.01）以及整个住院期间（MD：-307.76 MME，95% CI -461.72至-153.79，p < 0.01）。此外，冷冻镇痛组的疼痛评分显著降低（MD：-1.10分，95% CI -1.77至-0.43，p < 0.01）。然而，在住院LOS或拔管时间方面未发现显著差异。