成人急性胰腺炎早期镇痛，非阿片方案会比阿片类药物更合适吗？

急性胰腺炎（AP）患者常以明显腹痛起病，及时、充分的镇痛是早期治疗的重要环节。临床上阿片类药物常用于疼痛控制，但也需要关注恶心呕吐、肠道功能、呼吸抑制和用药安全等问题。非甾体抗炎药（NSAIDs）作为非阿片镇痛选择，能否在控制疼痛的同时保持相近安全性，仍需要随机对照试验证据回答。成人急性胰腺炎早期镇痛，非阿片方案会比阿片类药物更合适吗？

下面这篇文献将回答这个问题。

文献英文标题

Early Analgesia for the Management of Acute Pancreatitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

英文摘要要点

Methods:

A systematic literature search was conducted across PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and ClinicalTrials.gov from database/registry inception to December 2025 to obtain relevant data. Randomized controlled trials involving adults aged ≥18 years diagnosed with AP, irrespective of the etiology and severity, who were administered analgesics (opioids, non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, epidural anesthesia, local anesthesia, and paracetamol) and compared with placebo, conventional treatment, or another analgesic modality were included in this review. The primary outcome assessed was pain reduction. The secondary outcomes assessed were the need for rescue analgesia, length of hospital stay, complications (local and/or systemic), mortality, and adverse drug effects. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0. Effect estimates were pooled using a random-effects meta-analysis (DerSimonian-Laird approach), while non-pooled outcomes were summarized narratively.

Results:

A total of 13 studies were included in the analysis. NSAIDs provided pain relief comparable to opioids, with a lower incidence of local complications (RR: 0.59, 95% CI: 0.37-0.94). No significant differences in the need for rescue analgesia (OR: 0.88, 95% CI: 0.33-2.35), length of hospital stay (MD: -2.68 days, 95% CI: -6.27-0.91), mortality (RR: 0.76, 95% CI: 0.19-3.05), and adverse drug effects (RR: 0.55, 95% CI: 0.17-1.76) were observed. However, the findings are limited by study bias and heterogeneity.

Conclusions:

Early analgesia with NSAIDs has efficacy and safety comparable to opioids in adults with AP, with the advantage of reducing local complications.

文献标题中文翻译

急性胰腺炎（AP）管理中的早期镇痛：随机对照试验的系统评价与荟萃分析

文献简介

急性胰腺炎（AP）患者常需要在疾病早期接受镇痛治疗。研究者关注的是，早期镇痛干预，尤其是非甾体抗炎药（NSAIDs）与阿片类药物的比较，能否在成人急性胰腺炎患者中有效减轻疼痛、改善相关临床结局，并保持可接受的安全性。

付费阅读分界线

本文采取的研究方法

研究者从各数据库或注册库建库起检索至规定截止时间，检索范围包括PubMed、Embase、Cochrane中心随机对照试验注册库、Web of Science、Scopus和ClinicalTrials.gov等来源，以获取相关研究数据。主要结局为疼痛减轻。次要结局包括解救镇痛需求、住院时间、局部和/或系统性并发症、死亡率以及药物不良反应。研究者使用Cochrane偏倚风险评估工具2.0评估偏倚风险。可合并的效应量采用随机效应荟萃分析进行合并，不能合并的结局采用叙述性方式总结。

主要结果

共纳入13项研究进行分析。非甾体抗炎药（NSAIDs）与阿片类药物在镇痛效果方面相当，并且局部并发症发生率较低（风险比为0.59，95%置信区间为0.37–0.94）。

在解救镇痛需求、住院时间、死亡率和药物不良反应方面，研究未观察到显著差异。研究偏倚和异质性限制了这些发现的解释。

文章得出的结论

作者认为，在成人急性胰腺炎（AP）患者中，早期使用非甾体抗炎药（NSAIDs）镇痛的有效性和安全性与阿片类药物相当，并可能具有减少局部并发症的优势。

关于这个话题我们已知什么

急性胰腺炎（AP）患者的疼痛通常发生早、程度重，镇痛不足会影响患者舒适度、呼吸活动和整体治疗配合。临床上需要在及时镇痛、药物不良反应、器官功能状态和病情监测之间取得平衡。

这篇文章告诉我们什么新内容

这篇文献的新内容在于，它以系统评价和荟萃分析形式汇总随机对照试验证据，帮助读者从证据整体而非单个研究角度理解早期镇痛方案的有效性和安全性。

对麻醉医生的临床启示

对麻醉医生和急性疼痛管理团队而言，这篇文献提示，镇痛方案选择不应只关注疼痛评分，还应同时考虑解救镇痛需求、器官功能、不良反应和并发症风险。对于急性胰腺炎（AP）患者，非阿片镇痛策略可能为减少阿片暴露提供依据，但具体用药仍需结合肾功能、出血风险、胃肠功能和本院监测条件。

谨慎解读与局限性

系统评价和荟萃分析的结论取决于纳入研究质量、样本量、异质性和结局定义一致性。

如果纳入研究存在偏倚或干预方案差异较大，汇总结果需要谨慎解释。

本文结论不能简单等同于所有患者均适用的统一治疗方案。

参考文献

Early Analgesia for the Management of Acute Pancreatitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Pancreas. 2026. doi:10.1097/mpa.0000000000002676. PMID:42153651.