目的 系统评价羟考酮与吗啡比较用于术后静脉自控镇痛的有效性和安全性.方法 计算机检索PubMed、EMbase、The Cochrane Library (2015年8期)、CBM、CNKI、VIP和WanFang Data数据库,搜集关于羟考酮和吗啡比较用于术后静脉自控镇痛的随机对照试验(RCT),检索时限均为建库截至2015年8月.由2位研究者按纳入与排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 共纳入7个RCT,包括826名患者.Meta分析结果显示:在术后2h、3h、4h、8h、12h、24 h、36 h和48 h,两组镇痛效果的差异均无统计学意义[术后2 h:MD=0.20,95％CI(-0.18,0.58),P=0.30;术后3 h静态:MD=-0.51,95％CI(-2.27,1.26),P=0.57;术后3 h动态:MD=-0.46,95％CI(-2.23,1.40),P=0.63;术后4h:MD=0.00,95％CI(-0.25,0.25),P=0.99;术后8 h:MD=0.10,95％CI(-0.16,0.36),P=0.46;术后12 h:MD=-0.34,95％CI(-0.85,0.17),P=0.19;术后24h:MD=-0.13,95％CI(-0.43,0.17),P=0.41;术后36 h:MD=0.10,95％CI(-0.28,0.48),P=0.60;术后48 h:MD=-0.13,95％CI(-0.36,0.09),P=0.25].羟考酮在呕吐发生率[OR=0.23,95％CI (0.08,0.63),P=0.005]、恶心发生率[OR=0.27,95％CI (0.08,0.86),P=0.03]、呼吸抑制发生率[OR=0.15,95％ CI (0.04,0.53),t=0.003]和皮肤瘙痒发生率[OR=0.19,95％CI (0.05,0.66),P=0.009]方面低于吗啡组,而在术后头痛发生率、头晕发生率和寒战发生率方面,两者差异无统计学意义.结论 羟考酮用于术后静脉自控镇痛效果与吗啡相当,但不良反应发生率明显低于吗啡,临床应用更安全.受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以证实.“,”Objective To systematically review the efficacy and safety of oxycodone versus morphine for postoperative intravenous self-control analgesia (PCIA).Methods We searched databases including PubMed,EMbase,The Cochrane Library (Issue 8,2015),CBM,CNKI,VIP,WanFang Data from inception to August 2015,to collect randomized controlled trials (RCTs) about oxycodone versus morphine for postoperative PCIA.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then,meta-analysis was performed using RevMan 5.3 software.Results Seven RCTs involving 826 patients were included.The results of meta-analysis showed that:there were no significant differences in postoperative analgesia at the points of 2 h,3 h,4 h,8 h,12 h,24 h,36 h and 48 h after surgery (2 h:MD=0.20,95％CI-0.18 to 0.58,P=0.30;3 hrestingstate:MD=-0.51,95％CI-2.27 to 1.26,P=0.57;3 hdynamic state:MD=-0.46,95％CI-2.23 to 1.40,P=0.63;4 h:MD=0.00,95％CI-0.25 to 0.25,P=0.99;8 h:MD=0.10,95％CI-0.16 to 0.36,P=0.46;12 h:MD=-0.34,95％CI-0.85 to 0.17,P=0.19;24 h:MD=-0.13,95％CI-0.43 to 0.17,P=0.41;36 h:MD=0.10,95％CI-0.28 to 0.48,P=0.60;48 h:MD=-0.13,95％CI-0.36 to 0.09,P=0.25).The incidences of postoperative vomiting (OR=0.23,95％CI 0.08 to 0.63,P=0.005),nausea (OR=0.27,95％CI 0.08 to 0.86,P=0.03),respiratory depression (OR=0.15,95％CI 0.04 to 0.53,P=0.003) and skin pruritus (OR=0.19,95％CI 0.05 to 0.66,P=0.009) in the oxycodone group were lower than those in the morphine group.In addition,there were no significant differences of the incidences of headache,dizzy and shiver between two groups.Conclusion Compared with morphine,oxycodone has the same analgesia effect for PCIA,however,the incidences of adverse reactions are lower.Due to the limited quality and quantity of included studies,the above results are needed to be validated by more high quality studies.