目的 系統(tǒng)評價塞來昔布聯(lián)用阿片類藥物（嗎啡、羥考酮）治療中重度癌性疼痛的臨床療效和安全性。方法 檢索Cochrane Library、PubMed、中國生物醫(yī)學文獻數(shù)據(jù)庫（CBM）、中國學術期刊全文數(shù)據(jù)庫（CNKI）、維普中文期刊全文數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫關于塞來昔布聯(lián)用阿片藥物對比單用阿片類藥物治療中重度癌性疼痛的隨機對照試驗（RCTs），檢索時間為2000年1月—2019年7月。由2名研究者獨立提取數(shù)據(jù)、評價質(zhì)量，并交叉核對。采用RevMan 5.3軟件進行Meta-分析。結(jié)果 共納入12項RCTs，1 292例患者。Meta-分析結(jié)果顯示相對于單用阿片，塞來昔布聯(lián)用阿片藥物能顯著提高疼痛緩解率（OR=1.94，95%CI=1.64～2.59）、減少日均阿片藥物用量（MD=-10.64，95%CI=-15.03～-6.26）和提高生活質(zhì)量（MD=3.53，95%CI=1.34～5.72），差異均有統(tǒng)計學意義（P<0.01），按照阿片藥物類別進行亞組分析結(jié)果與上述Meta-分析結(jié)果一致。在安全性方面，塞來昔布能顯著降低嗎啡便秘、惡心嘔吐、嗜睡、頭痛頭暈發(fā)生率和羥考酮便秘發(fā)生率（P<0.01），對阿片藥物致排尿困難發(fā)生率無影響。結(jié)論 塞來昔布聯(lián)用阿片藥物用于中重度癌痛患者鎮(zhèn)痛療效確切，同時可顯著降低便秘和惡心嘔吐等發(fā)生率。

Objective To systematically evaluate the clinical efficacy and safety of celecoxib combined with opioid drugs (morphine, oxycodone) for the treatment of moderate to severe cancer pain. Methods Databases including Cochrane Library, PubMed, CBM, CNKI, VIP and Wanfang Database were searched to collect randomized controlled trials (RCTs) about celecoxib combined with opioid drugs combined vs opioid drugs alone for moderate to severe cancer pain from January 2000 to July 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of 12 RCTs, 1 292 patients were included. Meta-analysis showed that, compared with opioid drugs alone, celecoxib combined with opioid drugs could significantly improve the rate of pain relief (OR=1.94, 95%CI=1.64~2.59), reduce the daily average opioid dosage (MD=-10.64, 95%CI=-15.03~-6.26) and improve the quality of life (MD=3.53, 95%CI=1.34~5.72), the difference were statistically significant (P<0.01), Sub-group analysis by opioid category were consistent with Meta-analysis. In terms of safety, celecoxib significantly reduced the incidence of morphine in constipation, nausea and vomiting, drowsiness, headache and dizziness, and oxycodone constipation (P<0.01), but had no effect on the incidence of dysuria caused by opiates drugs. The funnel plot suggested that the publication bias was small. Conclusion Celecoxib combined with opioid drugs are effective for patients with moderate to severe cancer pain, and can significantly reduce the incidence of constipation, nausea and vomiting.

R971;R979.1

黃石市醫(yī)藥衛(wèi)生科研項目（2015-47）