目的 通过对腹部手术后自控静脉镇痛（PCIA）不同药物配方的研究，探讨酒石酸布托啡诺与舒芬太尼用于术后PCIA临床效果。 方法 将2012年2月－8月收治的60例麻醉分级为Ⅰ～Ⅲ级需术后镇痛的腹部手术患者（均无心、肺、肝、肾、脑、内分泌疾病及过敏史）随机分成两组：酒石酸布托啡诺组（N组，n=30），舒芬太尼组（S组，n=30）。观察镇痛效果和不良反应发生率。 结果 两组镇痛效果差异无统计学意义（P＞0.05），不良反应（包括恶心、呕吐、头晕、嗜睡、皮肤瘙痒、呼吸抑制、尿潴留等），N组发生率均低于S组（P＜0.05）。 结论 酒石酸布托啡诺用于PCIA安全、有效，不良反应少。
ObjectivesTo systematically review the efficacy and safety of sufentanil versus fentanyl used in patient-controlled intravenous analgesia (PCIA) after cesarean section.MethodsAn online search of computerized searches of the database of MEDLINE (OVID), Web of Science, The Cochrane Central Register of Controlled Trials, PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed were conducted. Randomized controlled trials published since the inceptions of these databases until April 1st 2018, involving the comparison of sufentanil versus fentanyl for PCIA after cesarean section were included. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 19 studies were included. The results of meta-analysis showed that, compared with the fentanyl group, the sufentanil group had statistically significant lower VAS scores at 4-hour (MD=–0.99, 95%CI –1.03 to –0.95, P<0.001), 8-hour (MD=–0.30, 95%CI –0.40 to –0.21, P<0.001), 12-hour (MD=–0.54, 95%CI –0.62 to –0.46, P<0.001) and 24-hour (MD=–0.35, 95%CI –0.41 to –0.28, P<0.001); statistically significant higher Ramsay scores at 4-hour (MD=0.72, 95%CI 0.66 to 0.78, P<0.001), 8-hour (MD=0.93, 95%CI 0.86 to 1.00, P<0.001), 12-hour (MD=0.98, 95%CI 0.91 to 1.05, P<0.001), 24-hour (MD=0.07, 95%CI 0.03 to 0.11, P=0.000 5), 48-hour (MD=0.05, 95%CI 0.03 to 0.08, P<0.000 1). As for the adverse reactions, sufentanil group had lower risks of having nausea and vomiting (RR=0.25, 95%CI 0.19 to 0.31, P<0.001), pruritus (RR=0.41, 95%CI 0.30 to 0.57, P<0.001), dizziness (RR=0.27, 95%CI 0.17 to 0.44, P<0.001) and urinary retention (RR=0.35, 95%CI (0.15, 0.82), P=0.02).ConclusionsThe current evidence shows that, sufentanil has better analgesia and sedative effects, and less risks of adverse reactions for safer clinical use.