镁对外科手术患者寒战的预防作用：系统回顾与Meta分析
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Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis
背景与目的
目前围术期镁的使用对寒战作用的临床试验结果不一，故本研究对围手术期镁预防寒战的效果进行了系统回顾和Meta分析。
方 法
本试验索了PubMed、EMBASE、Web of Science、Cochrane等数据库，以获得随机临床试验，这些试验比较了外科手术患者镁给药与安慰剂或不接受治疗对寒战的预防作用的情况。主要结果为寒战的发生率。采用随机效应模型分析寒战发生率[95%可信区间（CI）与风险比（RR）]； 行亚组分析评估给药途径的效果，并进行1型错误风险为5%和90%的试验序列分析；对每项试验进行质量评估，并使用推荐等级评估文章质量。本试验还分析不良事件发生情况。
结 果
本试验共纳入64个随机临床试验、4303名患者（分别为镁使用组和对照组的2300名和2003名患者）；镁使用组寒战总发生率为9.9%而对照组为23.0%（RR=0.42；95% CI：0.33-0.52）；亚组分析揭示静脉使用镁寒战发生率较低（RR=0.29；95% CI:0.29–0.54),硬膜外使用镁（RR=0.24；95% CI:0.13-0.43）,椎管内使用镁（RR=0.64；95% CI:0.43–0.96);低偏倚风险的试验被纳入试验序列分析;镁使用中无不良反应事件发生。
结 论
围手术期静脉注射镁能有效降低寒战的发生率，试验序列分析表明，不需要再进行试验来确认静脉注射镁能有效地减少寒战的发生。
原始文献摘要
Hiromasa Kawakami, Daisuke Nakajima,Takahiro Mihara,etal;Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis;Anesth Analg XXX;XXX:00–000
BACKGROUND: IV ketamine is widely used to treat patients with chronic pain, yet the long-term impact remains uncertain. We synthesized evidence from randomized control trials to investigate the effectiveness of IV ketamine infusions for pain relief in chronic conditions and to determine whether any pain classifications or treatment regimens are associated with greater benefit.
METHODS: We searched Medline, Embase, and Google Scholar, as well as the clinicaltrials.gov website from inception through December 16, 2017 for randomized control trials comparing IV ketamine to placebo infusions for chronic pain that reported outcomes for 48 hours after the intervention. Three authors independently screened the studies, pooled the data, and appraised risk of bias. Random-effects model was used to calculate weighted mean differences for pain scores and secondary outcomes. Our primary outcome was the lowest recorded pain score 48 hours after cessation of treatment. Secondary outcomes included responder rate and adverse effects.
RESULTS: Among 696 studies assessed for eligibility, 7 met inclusion criteria. All studies except one were at high risk of bias. These studies randomly assigned 211 patients with neuropathic (n = 2), mixed (n = 2), and nonneuropathic (nociplastic or nociceptive) (n = 3) pain. Three studies reported significant analgesic benefit favoring ketamine, with the meta-analysis revealing a small effect up to 2 weeks after the infusion (mean difference in pain scores, 1.83 points on a 0 10 numerical rating scale; 95% CI, 2.35 to 1.31 points; P < .0001). In the 3 studies that reported responder rates, the proportion with a positive outcome was greater in the ketamine than in the placebo group (51.3% vs 19.4%; relative risk, 2.43; 95% CI, 1.10 5.40; P = .029; I2 = 0.0%). No differences were noted based on pain classification or condition. Compared to low-dose ketamine studies and investigations that evaluated non complex regional pain syndrome conditions, a small but nonsignificant greater reduction in pain scores was found among studies that either utilized high-dose ketamine therapy (P = .213) or enrolled complex regional pain syndrome patients (P = .079).
CONCLUSIONS: Evidence suggests that IV ketamine provides significant short-term analgesic benefit in patients with refractory chronic pain, with some evidence of a dose response relationship. Larger, multicenter studies with longer follow-ups are needed to better select patients and determine the optimal treatment protocol.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：何幼芹 审校：王贵龙