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本公眾號(hào)每天分享一篇最新一期Anesthesia & Analgesia等SCI雜志的摘要翻譯，敬請(qǐng)關(guān)注并提出寶貴意見 Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and inpatient surgery: a systematic review and meta-analysis 背景與目的 丙泊酚?于麻醉維持是否優(yōu)于吸?麻醉藥?前尚不清楚。本研究旨在?較丙泊酚與吸?麻醉劑?于維持全身麻醉時(shí)對(duì)患者相關(guān)性結(jié)果和患者滿意度的影響。 方 法 通過檢索PubMed?、EMBASE?和Cochrane?數(shù)據(jù)庫，收集1985年1?1??2016年8?1?同?評(píng)審期刊中的隨機(jī)對(duì)照試驗(yàn)（RCTs）。從6688項(xiàng)研究中，納?了229例RCTs，共20991例患者。根據(jù)Cochrane標(biāo)準(zhǔn)進(jìn)?質(zhì)量控制，評(píng)估偏倚?險(xiǎn)、meta偏倚、meta回歸并確定資料可靠性，從存在異質(zhì)性的固定或隨機(jī)效應(yīng)模型中導(dǎo)出?般估計(jì)。術(shù)后惡?嘔吐（PONV）作為主要結(jié)果；術(shù)后疼痛、緊張焦慮、恢復(fù)時(shí)間、住院時(shí)間、麻醉后寒戰(zhàn)和?流動(dòng)?學(xué)不穩(wěn)定性作為次要結(jié)果。 結(jié) 果 丙泊酚組的PONV?險(xiǎn)低于吸?麻醉劑組（相關(guān)?險(xiǎn)度（RR）0.61[0.53, 0.69],p < 0.00001）。此外，丙泊酚組拔管后疼痛評(píng)分和麻醉復(fù)蘇室（PACU）內(nèi)停留時(shí)間均減少（平均差異（MD） ? 0.51 [? 0.81, ?0.20], p = 0.001; MD ? 2.91 min [? 5.47, ? 0.35],p = 0.03）。相反地，丙泊酚組的呼吸恢復(fù)時(shí)間和?管導(dǎo)管拔除時(shí)間較吸?麻醉劑組?（MD0.82 min [0.20, 1.45], p = 0.01; MD 0.70 min [0.03, 1.38], p = 0.04）。值得注意的是，丙泊酚組的患者滿意度（滿意患者數(shù)量和評(píng)分）更?（RR1.06 [1.01, 1.10], p = 0.02; MD 0.13 [0.00, 0.26], p = 0.05）。次要結(jié)果分析與主要結(jié)果?致。 結(jié) 論 本項(xiàng)meta分析結(jié)果顯示丙泊酚?于麻醉維持優(yōu)于吸?麻醉藥。雖然丙泊酚可提?患者滿意度，但仍需進(jìn)?充分有?的前瞻性臨床試驗(yàn)以解決其臨床應(yīng)?和經(jīng)濟(jì)相關(guān)性等問題。 原始文獻(xiàn)摘要 Schraag S,Pradelli L,Alsaleh AJO,et al.Propof ol vs. inhalational agents to maintain general anaesthesia in ambulatory and inpatient surgery: a systematic review and meta-analysis[J].BMC Anesthesiol, 2018 Nov 8;18(1):162-171. doi: 10.1186/s12871-018-0632-3. Background: It is unclear if anaesthesia maintenance with propof ol is advantageous or beneficial over inhalational agents. This study is intended to compare the eff ects of propof ol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisf action. Methods: Studies were identified by electronic database searches in PubMed , EMBASE and the Cochrane library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied. Of 6688 studies identified, 229 RCTs were included with a total of 20,991 patients. Quality control,assessment of risk of bias, meta-bias, meta-regression and certainty in evidence were perf ormed according to Cochrane.Common estimates were derived f rom fixed or random-eff ects models depending on the presence of heterogeneity. Post-operative nausea and vomiting (PONV) was the primary outcome. Postoperative pain,emergence agitation, time to recovery, hospital length of stay, post-anaesthetic shivering and haemodynamicinstability were considered key secondary outcomes. Results: The risk f or PONV was lower with propof ol than with inhalational agents (relative risk (RR) 0.61 [0.53, 0.69],p < 0.00001). Additionally, pain score af ter extubation and time in the postoperative anaesthesia care unit (PACU) were reduced with propof ol (mean diff erence (MD) 0.51 [ 0.81, 0.20], p = 0.001; MD 2.91 min [ 5.47, 0.35],p = 0.03). In turn, time to respiratory recovery and tracheal extubation were longer with propof ol than with inhalational agents (MD 0.82 min [0.20, 1.45], p = 0.01; MD 0.70 min [0.03, 1.38], p = 0.04, respectively). Notably,patient satisf action, as reported by the number of satisfied patients and scores, was higher with propof ol (RR 1.06 [1.01, 1.10], p = 0.02; MD 0.13 [0.00, 0.26], p = 0.05). Secondary analyses supported the primary results. Conclusions: Based on the present meta-analysis there are several advantages of anaesthesia maintenance with propof ol over inhalational agents. While these benefits result in an increased patient satisf action, the clinical andeconomic relevance of these findings still need to be addressed in adequately powered prospective clinical trials. 麻醉學(xué)文獻(xiàn)進(jìn)展分享 貴州醫(yī)科大學(xué)高鴻教授課題組 編輯：余曉旭 審校：王貴龍 |
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