七氟醚与丙泊酚用于成人开颅手术麻醉的比较：系统评价与Meta分析

doi:10.3969/j.issn.1006-7795.2013.05.020

摘要/Abstract

摘要：

目的系统评价七氟醚与丙泊酚用于成人开颅手术麻醉的效果及安全性。方法电子检索PubMed、EMbase、Cochrane图书馆、中国知网、维普等数据库,收集比较七氟醚和丙泊酚用于成人开颅手术麻醉维持的随机对照研究。按Cochrane系统评价员手册评价纳入研究的质量、提取数据,采用RevMan软件进行Meta分析。结果纳入RCT研究17篇,共1 330例患者。Meta分析结果显示:①丙泊酚组的术中脑松弛度[RR=0.95, 95% CI (0.91, 0.24), P=0.02]、打开骨瓣前颅内压[MD=3.81, 95% CI (2.80, 4.82), P<0.000 01]优于七氟醚组;颈静脉球血氧饱和度较七氟醚组低[MD=10.24, 95% CI (7.87, 12.61), P<0.000 01]。②2组术中高血压、低血压、心动过速、心动过缓的发生率差异无统计学意义。③2组睁眼时间、拔管时间、术后寒战发生率相似,丙泊酚组术后恶心/呕吐的发生率低于七氟醚组[RR=1.56, 95% CI (1.16, 2.10), P=0.004]。结论在开颅手术中,丙泊酚静脉麻醉能为术者提供更好的脑松弛度、降低打开骨瓣前颅内压、减少术后恶心/呕吐发生率。

关键词: 七氟醚, 丙泊酚, 开颅手术, Meta分析

Abstract:

Objective To evaluate the efficacy and safety of sevoflurane and propofol anesthesia for craniotomy in adults.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and other electronic databases were used to collect the randomized controlled trails (RCTs) on sevoflurane in comparison with propofol for the maintenance of anesthesia for craniotomy in adults. The risks of bias in the included studies were assessed in accordance with The Cochrane Handbook for Systematic Reviews of Interventions. After data extraction, Meta-analysis was performed with RevMan software. Results A total of 17 RCTs involving 1 330 patients were included. The results of Meta-analysis demonstrated that compared with sevoflurane anesthesia, propofol tended to provide better brain relaxation [RR=0.95, 95% CI (0.91, 0.24), P=0.02], lower intracranial pressure (ICP) before skull flap removing [MD=3.81, 95%CI (2.80, 4.82), P < 0.000 01] and lower oxygen saturation of jugular vein bulb (SjvO2) [MD=10.24, 95% CI (7.87, 12.61), P < 0.000 01]. It was shown that there were no significant differences between the two groups in adverse events such as intraoperative hypertension, hypotension, tachycardia and bradycardia, and postoperative shivering. In addition, it was indicated that both eye-opening time and extubation time were similar in the two groups. The incidence of postoperative nausea and vomiting (PONV) was lower in propofol group compared to sevoflurane group [RR=1.56, 95% CI (1.16, 2.10), P=0.004]. Conclusion The current evidence shows that intravenous anesthesia with propofol anesthesia provides better brain relaxation, lower ICP before skull flap removing and decreased occurrence of PONV in comparison with sevoflurane.

Key words: sevoflurane, propofol, craniotomy, Meta-analysis

中图分类号:

R614

于芸, 张凯颖, 韩如泉. 七氟醚与丙泊酚用于成人开颅手术麻醉的比较：系统评价与Meta分析[J]. 首都医科大学学报, 2013, 34(5): 733-741.

YU Yun, ZHANG Kaiying, HAN Ruquan. Sevoflurane versus propofol anesthesia for craniotomy in adults：a systematic review and meta-analysis[J]. Journal of Capital Medical University, 2013, 34(5): 733-741.

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