术前睡眠剥夺诱导术后疼痛敏化的证据图分析

Evidence Graph Analysis of Postoperative Pain Sensitization Induced by Perioperative Sleep Deprivation

  • 摘要: 目的 通过证据图系统描述和评价术前睡眠剥夺导致术后疼痛敏化的临床研究,了解该领域的证据分布,为后续证据研究提供参考。 方法 计算机检索 PubMed、 Embase、 Cochrane Library、 Webof Science、中国知网、万方数据知识服务平台、维普和中国生物医学文献数据库 8 个数据库,检索时间从建库至 2023 年 8 月,获取术前睡眠剥夺导致术后疼痛敏化的干预性研究、观察性研究和系统评价/Meta 分析,对其研究特征、方法学质量进行分析和评价。分别采用 Cochrane 系统评价手册、纽卡斯尔-渥太华量表( Newcastle-Ottawa Scale, NOS)、 AMSTAR-2 量表对纳入的研究进行质量评估,并采用图表与文字相结合的方式对证据进行综合分析与展示。 结果 最终纳入 35 项观察性研究( 31 项队列研究、 4 项病例对照研究)、 15 项随机对照试验和 4 项系统评价/Meta 分析。在发文量方面, 2018 年以后迅速增加,并于 2022 年达到峰值,且该领域临床研究主要集中在队列研究,随机对照试验和系统评价/Meta 分析研究较少。证据图结果显示, 22 项研究为“高质量”, 24 项研究为“中等质量”, 8 项研究为“低质量”,多数研究结果表明术前睡眠剥夺可诱导术后疼痛敏化, 仅 2 项研究认为睡眠障碍与术后疼痛敏化无明显关联, 9 项研究不确定睡眠剥夺可诱导术后疼痛敏化。 结论 整体证据表明, 术前睡眠剥夺可诱导术后疼痛敏化,但评价维度单一且纳入文献的方法学质量有待提高,建议未来开展更多高质量、大样本、规范的临床研究, 为临床工作提供科学的依据。

     

    Abstract: Objective To describe and evaluate the clinical studies of postoperative pain sensitization caused by sleep deprivation through the evidence map system, to understand the distribution of evidence in this field, and to provide reference for subsequent evidence research. Methods A computer-based search of PubMed, EMBASE, Cochrane library, Web of Science, CNKI, Wanfang Data, VIP and Chinese Biomedical Literature Database from inception to August 2023 was conducted to obtain intervention studies, observational studies and systematic review / meta-analysis of postoperative pain sensitization caused by sleep deprivation. The research characteristics and methodological quality were analyzed and evaluated. The Cochrane Handbook for Systematic Reviews, the Newcastle-Ottawa Scale (NOS) and the AMSTAR-2 scale were used to evaluate the quality of the included studies, and the evidence was comprehensively analyzed and displayed by means of bubble chart, table and text. Results A total of 35 observational studies (31 cohort studies, 4 case-control studies), 15 randomized controlled trials and 4 systematic reviews / meta-analyses were included. In terms of the number of publications, it increased rapidly after 2018 and peaked in 2022, and clinical studies in this field mainly focused on cohort studies, with fewer randomized controlled trials and systematic reviews / Meta-analysis studies. The results of the evidence map showed that the quality of 22 studies was 'high quality', 24 studies were 'medium quality', and 8 studies were 'low quality'.Most of the studies showed that sleep deprivation could induce postoperative pain sensitization. Only 2 studies suggested that sleep disorders were not significantly associated with postoperative pain sensitization, and 9 studies were uncertain that sleep deprivation could induce postoperative pain sensitization. Conclusion Overall evidence shows that sleep deprivation can induce postoperative pain sensitization, but the evaluation dimension is single and the methodological quality of the included literature needs to be improved. It is suggested that more high-quality, large-sample and standardized clinical studies should be carried out in the future to provide scientific basis for clinical work.

     

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