背景:尽管以前的文章和评论表明氯胺酮可以有效地治疗创伤患者的疼痛,这些文章有严重的局限性。因此,本荟萃分析旨在探讨氯胺酮在创伤患者院前疼痛管理中的疗效.
方法:在本荟萃分析中,包括对照人体研究。在包括Medline(通过PubMed)在内的电子数据库中进行了广泛的搜索,Embase,中央,Scopus,WebofScience,和ProQuest,收集到2018年底的数据。根据标准平均差(SMD)和比值比(OR)计算,以95%置信区间(95%CI)将氯胺酮在院前疼痛管理中的疗效和副作用与阿片类镇痛药进行比较。
结果:本荟萃分析包括来自7篇文章的数据。在创伤患者的院前疼痛管理中,氯胺酮给药并不比吗啡或芬太尼更有效(SMD=-0.56,95%CI:-1.38至0.26,p=0.117)。然而,氯胺酮+吗啡联合给药比氯胺酮单独给药有效得多,在缓解院前设置中的疼痛(SMD=-0.62,95%CI:-1.12至-0.12,p=0.010)。最后,结论氯胺酮单药比吗啡单药副作用少(OR=0.25,95%CI:0.11~0.56,p=0.001).然而,与单独使用吗啡相比,氯胺酮+吗啡联合给药的副作用风险增加到3.68倍(OR=3.68,95%CI:1.99~6.82,p<0.001).
结论:第一次,当前荟萃分析的结果表明,氯胺酮,单独管理,是创伤患者院前疼痛管理的有效和安全的药物,并且可以被认为是阿片类镇痛药的可接受替代品。
BACKGROUND: Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of trauma patients.
METHODS: In the present meta-analysis, controlled human studies were included. An extensive search was conducted in electronic databases including Medline (via PubMed), Embase, Central, Scopus, Web of Science, and ProQuest, gathering data to the end of 2018. The efficacy and side effects of ketamine administration in pre-hospital pain management were compared with those of opioid analgesics based on standard mean difference (SMD) and odds ratio (OR) calculations with 95% confidence interval (95% CI).
RESULTS: Data from seven articles were included in the present meta-analysis. Ketamine administration was not more effective than administrating morphine or fentanyl in prehospital pain management of trauma patients (SMD = -0.56, 95% CI: -1.38 to 0.26, p = 0.117). However, co-administration of ketamine+morphine was considerably more effective than ketamine alone, in alleviating pain in prehospital settings (SMD = -0.62, 95% CI: -1.12 to -0.12, p = 0.010). Finally, it was concluded that ketamine alone had less side effects than morphine alone (OR = 0.25, 95% CI: 0.11 to 0.56, p = 0.001). However, co-administration of ketamine+morphine increases the risk of side effects to 3.68 times compared to when morphine is prescribed solely (OR=3.68, 95% CI: 1.99 to 6.82, p<0.001).
CONCLUSIONS: For the first time, findings of the current meta-analysis demonstrated that ketamine, being administered alone, is an effective and safe medication in prehospital pain management in trauma patients, and can be considered as an acceptable alternative to opioid analgesics.