成人心脏手术患者局部麻醉药连续伤口浸润：一项符合PRISMA的系统评价和荟萃分析。
完整摘要 · 中文译文
背景：有效的术后镇痛对于心脏手术后的恢复至关重要。已有人提出使用局部麻醉药（LAs）进行连续伤口浸润（CWI）作为一种减少阿片类药物的辅助手段，但其在疼痛控制之外的疗效及安全性尚未完全明确。 方法：我们进行了一项符合PRISMA声明的系统评价和荟萃分析，纳入比较成人心脏手术中连续伤口浸润（CWI）与对照组的随机对照试验（RCTs）。检索了PubMed、Embase和Cochrane CENTRAL数据库，检索时间从建库至2025年8月30日，并于2026年4月2日更新。主要结局为术后视觉模拟评分法（VAS）疼痛评分和累计吗啡消耗量。次要结局包括机械通气持续时间、住院时间、死亡率、并发症、患者满意度和不良事件。使用Cochrane RoB 2.0工具评估偏倚风险，并使用推荐意见分级评估、制定与评价（GRADE）方法评估证据确定性。 结果：共纳入12项随机对照试验，涉及2,117例患者。CWI在活动时显著降低24小时VAS（MD=-0.93，95%置信区间[CI]：-1.53至-0.33，P=0.002）和48小时VAS（MD=-0.80，95%CI：-1.17至-0.44，P<0.001），并减少48小时吗啡消耗量（MD=-8.10 mg，95%CI：-13.41至-2.79，P=0.003）。在静息时VAS、机械通气持续时间、ICU或住院时间、死亡率、主要心血管、肺、肾、胃肠道并发症或术后感染方面，未观察到显著影响。CWI下患者满意度更高。技术并发症罕见，未报告有临床意义的LA毒性。结论：在成人心脏手术中，含LA的CWI在活动时适度改善镇痛并减少阿片类药物需求，但在改善主要临床结局或住院时间方面无明确获益。CWI似乎安全可行，可作为多模式、减少阿片类镇痛策略的辅助手段。需要进一步具有充分把握度的试验来确定其在当代加速康复外科路径中的相对有效性。
完整摘要 · 英文原文
BACKGROUND: Effective postoperative analgesia is critical to recovery after cardiac surgery. Continuous wound infiltration (CWI) with local anesthetics (LAs) has been proposed as an opioid-sparing adjunct, but its efficacy beyond pain control and its safety profile remain incompletely defined. METHODS: We conducted a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CWI with control in adult cardiac surgery. PubMed, Embase, and Cochrane CENTRAL were searched from inception to August 30, 2025, and updated on April 2, 2026. Primary outcomes were postoperative Visual Analogue Scale (VAS) pain scores and cumulative morphine consumption. Secondary outcomes included mechanical ventilation duration, length of stay, mortality, complications, patient satisfaction, and adverse events. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Twelve RCTs involving 2,117 patients were included. CWI significantly reduced VAS during mobilization at 24 h (MD=-0.93, 95% confidence interval [CI]: -1.53--0.33, P = 0.002) and 48 h (MD=-0.80, 95% CI: -1.17--0.44, P < 0.001), and decreased 48-hour morphine consumption (MD=-8.10 mg, 95% CI: -13.41--2.79, P = 0.003). No significant effects were observed on VAS at rest, mechanical ventilation duration, ICU or hospital length of stay, mortality, or major cardiovascular, pulmonary, renal, gastrointestinal complications, or postoperative infections. Patient satisfaction was higher with CWI. Technical complications were uncommon, and no clinically significant LA toxicity was reported. CONCLUSIONS: In adult cardiac surgery, CWI with LAs modestly improves analgesia during mobilization and reduces opioid requirements without clear improvement in major clinical outcomes or length of stay. CWI appears safe and feasible and may serve as an adjunct in multimodal, opioid-sparing analgesia strategies. Further adequately powered trials are warranted to define its comparative effectiveness within contemporary enhanced recovery after surgery pathways.