静脉注射镁剂对非心脏手术后吗啡用量的影响：系统综述和Meta分析
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Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis.
背景与目的
有研究表明，静脉注射镁剂可以减少术后阿片类药物的消耗和疼痛强度，但另有研究报告与该结果相互矛盾。静脉注射镁剂在非心脏手术中的有效性和安全性尚不确定。因此，本研究旨在探讨静脉注射镁剂对成人非心脏手术患者术后24小时吗啡用量的影响。
方 法
检索MEDLINE、EMBASE、CENTRAL数据库从成立之初到2019年1月发表的所有在非心脏手术中比较静脉注射镁剂与安慰剂的随机临床试验的相关文献。排除观察性研究、病例报告、病例系列和非系统综述。
结 果
本研究共纳入51个试验(n=3311)并进行定量Meta分析。与安慰剂相比，镁剂组术后24h吗啡用量明显减少，平均差值[95%CI]为-5.6 mg (-7.54 ~ -3.66,P<0.001,I2=92%,证据水平偏低)。镁剂对术后吗啡用量影响的试验序贯分析是结论性的。接受镁剂治疗的患者首次镇痛时间较长[143 (103 to 183) min，P<0.001，I2=99%，证据水平低]，寒战发生率较低[0.26（0.15~0.44），P<0.001，I2=35%，证据水平很低]。然而，术后24小时的疼痛评分（平均差异，95%CI -0.30(-0.69~0.09，P=0.13，I2=91%，证据水平低)、心动过缓(OR，95%CI)1.13(0.43~2.98，P=0.80，I2=35%，证据水平极低)、术后恶心呕吐(OR，95%CI)0.90(0.67~1.22，P=0.49，I2=25%，证据水平中等)并无显著性差异。
结 论
本研究分析表明，在非心脏手术的患者中静脉使用镁剂作为多模式镇痛的一部分，可以减少术后24小时的吗啡用量，并延迟接受非心脏手术的患者首次要求镇痛的时间。然而，纳入的研究质量较低，具有很大的异质性。
原始文献来源及摘要
Ng KT, Yap JLL, Izham IN,et,al. The effect of intravenous magnesium on postoperative morphine consumption in noncardiac surgery A systematic review and meta-analysis with trial sequential analysis[J].Eur J Anaesthesiol 2020 Mar;37(3) DOI：10.1097/EJA.0000000000001164
BACKGROUND Several studies suggest that systemic magnesium reduces postoperative opioid consumption and the intensity of pain, but others report conflicting results. The efficacy and safety profile of intravenous magnesium in noncardiac surgery remain uncertain.
OBJECTIVES The aim of this review was to investigate the effect of intravenous magnesium on the consumption of postoperative morphine in the first 24h in adults undergoing noncardiac surgery.
DESIGN Systematic review and meta-analysis with trial sequential analysis.
DATA SOURCES MEDLINE, EMBASE, CENTRAL from their inception until January 2019.
ELIGIBILITY CRITERIA All randomised clinical trials comparing intravenous magnesium versus placebo in noncardiac surgery were systematically searched in the databases. Observational studies, case reports, case series and nonsystematic reviews were excluded.
RESULTS Fifty-one trials (n=3311) were included for quantitative meta-analysis. In comparison with placebo, postoperative morphine consumption at 24h was significantly reduced in the magnesium group, with a mean difference [95% confidence interval (CI)] of -5.6 mg (-7.54 to -3.66,P<0.001,I2=92%, level of evidence low). The trial sequential analysis for the effect of magnesium on postoperative morphine consumption was conclusive. Patients who received magnesium had a longer time to the first analgesia request [143 (103 to 183) min, P<0.001, I2=99%, level of evidence low] and a lower incidence of shivering [0.26 (0.15 to 0.44), P<0.001, I2=35%, level of evidence very low]. However, no significance differences were demonstrated in postoperative pain scores in the first 24h (mean difference,95% CI) -0.30 (-0.69 to 0.09, P=0.13, I2=91%, level of evidence low), bradycardia (odds ratio, 95% CI) 1.13 (0.43 to 2.98, P=0.80, I2=35%, level of evidence very low) and postoperative nausea and vomiting (odds ratio, 95% CI)0.90 (0.67 to 1.22, P=0.49, I2=25%, level of evidence moderate).
CONCLUSION The current meta-analysis demonstrates that the use of intravenous magnesium as part of multimodal analgesia may reduce morphine consumption in the first 24h after surgery and delay the time to the first request for analgesia in patients undergoing noncardiac surgery. However, the included studies were of low-quality with substantial heterogeneity.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙