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伤害感受水平指数指导的阿片类药物给药是否能减少术中阿片类药物的消耗？一项系统回顾和荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：王婷婷 编辑：王婷婷 审校：曹莹
背景：伤害感受水平（NOL）指数是一个从生理信号中提取的定量参数，用于测量术中伤害感受。本系统性综述和荟萃分析的目的是评价与常规治疗（临床医生酌情给予阿片类药物）相比，NOL监测是否减少了术中阿片类药物的使用。
方法：该荟萃分析包括在接受任何类型手术的成人患者中比较NOL指导的阿片类药物给药与常规治疗的随机临床试验。对PubMed、Scopus和CENTRAL数据库进行了系统检索。主要结局是术中阿片类药物消耗量，使用标准化平均差（SMD）测量NOL指数的效应估计值，其中0.20被认为是小效应量，0.80被认为是大效应量。采用Hartung-Knapp-Sidik-Jonkman调整的随机效应模型估计治疗效果。临床和统计学（使用不一致性I²统计量，预测区间和影响分析）探讨了异质性。使用推荐、评估、开发和评价分级（GRADE）指南方法评价证据的质量（确定性）。
结果：本综述包括9项试验（519例患者）。术中阿片类SMD（NOL监测与常规治疗）为−0.26（95%置信区间[CI]，−0.82至0.30; P = 0.31;证据确定性低）。我们观察到大量的临床（术中阿片类药物方案）和统计学异质性，I²统计量为86%（95% CI，75%-92%）。预测区间在-1.95至1.42之间，表明如果将来进行类似的研究，NOL和常规治疗之间的SMD将位于何处。
结论：这项荟萃分析没有提供证据支持NOL监测在减少术中阿片类药物消耗方面的作用。
Does Nociception Level Index-Guided Opioid Administration Reduce Intraoperative Opioid Consumption? A Systematic Review and Meta-Analysis
BACKGROUND: The nociception level (NOL) index is a quantitative parameter derived from physiological signals to measure intraoperative nociception. The aim of this systematic review and meta-analysis was to evaluate if NOL monitoring reduces intraoperative opioid use compared to conventional therapy (opioid administered at clinician discretion).
METHODS: This meta-analysis comprises randomized clinical trials comparing NOL-guided opioid administration to conventional therapy in adult patients undergoing any type of surgery. A systematic search of PubMed, Scopus, and CENTRAL databases was conducted. The primary outcome was intraoperative opioid consumption and the effect estimate of the NOL index was measured using the standardized mean difference (SMD) where 0.20 is considered a small and 0.80 a large effect size. A random-effects model with Hartung-Knapp-Sidik-Jonkman adjustment was applied to estimate the treatment effect. Heterogeneity was explored clinically and statistically (using the inconsistency I² statistic, prediction intervals, and influence analysis). The quality (certainty) of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines methodology.
RESULTS: This review comprised 9 trials (519 patients). The intraoperative opioid SMD (NOL monitoring versus conventional therapy) was −0.26 (95% confidence interval [CI], −0.82 to 0.30; P = .31; low certainty of evidence). We observed substantial clinical (intraoperative opioid regimens) and statistical heterogeneity with the I² statistic being 86% (95% CI, 75%–92%). The prediction interval was between −1.95 and 1.42 indicating where the SMD between NOL and conventional therapy would lie if a similar study were conducted in the future.
CONCLUSIONS: This meta-analysis does not provide evidence supporting the role of NOL monitoring in reducing intraoperative opioid consumption.
