几个常用全身麻醉药苏醒特征的系统评价

发布时间：2018-04-19 13:35

本文选题：七氟醚 + 丙泊酚　；参考：《兰州大学》2014年硕士论文

【摘要】：研究目的七氟醚因具有诱导时间短、苏醒快、麻醉平稳的特点,广泛应用于儿科麻醉。丙泊酚是目前临床上使用最广泛的静脉麻醉药,静脉注射后起效快,苏醒质量高。大量研究发现,七氟醚麻醉后小儿躁动发生率较高,亦有一部分研究显示,七氟醚和丙泊酚两种麻醉方式下没有差异。但七氟醚吸入麻醉后小儿躁动的研究尚缺乏高质量循证医学证据。近年来,关于氙气与其他麻醉药物比较的临床研究逐渐增多,对于手术时间较长,苏醒速度有要求的病人,氙气具有潜在的临床价值。因此,本研究分为两部分,采用Meta分析方法分别评价：(1)七氟醚吸入麻醉和丙泊酚静脉麻醉后对小儿躁动的影响,旨在为患儿围手术期麻醉方案的制定提供临床依据；(2)研究比较氙气和七氟醚的苏醒特征,并与临床使用最多的异氟醚进行比较,研究其各自的优缺点。研究方法 1.计算机检索PubMed(1966-2012.12).EMbase(1974-2012.12).Web of science(1945-2012.12).The Cochrane Library(2012年第4期)、CBM(1978-2012.12).CNKI(1979-2012.12).万方数据库(1998-2012.12)和维普数据库(1989-2012.12)。纳入比较七氟醚和丙泊酚麻醉影响小儿术后躁动的随机对照试验(RCT)；纳入比较氙气和异氟醚、氙气和七氟醚麻醉后苏醒特征的随机对照试验；追溯纳入研究的参考文献。 2.由两位研究者按照纳入与排除标准独立筛选文献、提取资料、使用Cochrane系统评价方法评价纳入研究的方法学质量。 3.用RevMan5.1.7软件进行Meta分析,评价七氟醚和丙泊酚麻醉影响小儿术后躁动发生情况,研究比较氙气和七氟醚的苏醒特征。研究结果 1.比较七氟醚和丙泊酚对小儿术后躁动的研究共纳入9个随机对照试验,Meta分析合成6个,共计692例患儿。Meta分析结果显示：①经七氟醚诱导后,丙泊酚维持组的躁动发生率低于七氟醚维持组[RR=0.57,95%CI(0.39,0.84)]；②全凭丙泊酚静脉麻醉组的躁动发生率低于全凭七氟醚吸入麻醉组[RR=0.16,95%CI(0.06,0.39)]。 2.比较氙气和七氟醚的苏醒特征的研究纳入6个随机对照试验,共计449例患者。Meta分析结果显示：①与异氟醚相比,氙气麻醉后睁眼时间较短[SMD=-1.07,95%CI(-1.31,-0.82)](SMD:标准化均数差)；拔管时间较短[SMD=-2.04,95%CI(-3.30,-0.78)];5分钟后Aldrete评分无统计学差异[SMD=3.34,95%CI(-0.49,6.76)]。②与七氟醚相比,氙气麻醉后睁眼时间较短[SMD=-1.54,95%CI(-2.00,-1.07)];拔管时间较短[SMD=-3.72,95%CI(-4.90,-2.55)]；恢复方向感时间较短[SMD=-2.20,95%CI(-3.84,-0.56)];恢复倒数数字时间较短[SMD=-1.07,95%CI(-1.31,-0.82)]; PONV发生率没有统计学差异[RR=1.26,95%CI(0.67,-2.38)]。研究结论 Meta分析结果表明：(1)七氟醚麻醉小儿术后躁动发生率高于丙泊酚麻醉,相比七氟醚,小儿父母对丙泊酚麻醉的满意度更高。(2)相比异氟醚和七氟醚麻醉,氙气麻醉后苏醒迅速；氙气和异氟醚麻醉后的病人的Aldrete评分没有区别；氙气和七氟醚麻醉PONV发生率没有区别,氙气麻醉术后认知能力恢复较早。受纳入研究数量与质量的限制,临床上在选择麻醉方式之前,应该对患儿的各方面情况进行综合考虑。
[Abstract]:research objective
Sevoflurane is widely used in pediatric anesthesia because of its short induction time, quick revival and smooth anesthesia. Propofol is the most widely used intravenous anesthetic at present. After intravenous injection, the effect is fast and the quality of awakening is high. A large number of studies have found that the incidence of manic activity in children after sevoflurane anesthesia is high, and some studies have shown sevoflurane. There is no difference between the two methods of anaesthesia with propofol. However, the study of agitation in children after sevoflurane inhalation is still lack of evidence of high quality evidence-based medicine. In recent years, the clinical study of xenon with other anesthetics has increased gradually, and xenon has a potential clinical value for patients with a longer operation time and a demanding recovery. Therefore, the study is divided into two parts. The Meta analysis method is used to evaluate the effects of sevoflurane inhalation and propofol intravenous anesthesia on children's restlessness. The purpose is to provide clinical basis for the formulation of perioperative anesthesia for children. (2) compare the revival characteristics of xenon and seven fluoro ether, and the most clinical use of isoflurane. Compare their respective advantages and disadvantages.
research method
1. computer retrieves PubMed (1966-2012.12).EMbase (1974-2012.12).Web of Science (1945-2012.12).The Cochrane Library (2012 fourth). A randomized controlled trial involving the comparison of xeno and isoflurane, xenon and sevoflurane anaesthesia after induction of anesthesia was included in the study (RCT).
2. two researchers independently screened the literature according to inclusion and exclusion criteria, extracted data, and evaluated the methodological quality of the included studies using Cochrane system evaluation.
3. Meta analysis was carried out by RevMan5.1.7 software to evaluate the effects of sevoflurane and propofol on the postoperative agitation of children, and to compare the revival characteristics of xenon and sevoflurane.
The results of the study
1. a total of 9 randomized controlled trials were included in the study of postoperative agitation of children with sevoflurane and propofol. 6 were synthesized by Meta analysis. The results of.Meta analysis in a total of 692 children showed that after sevoflurane induction, the incidence of agitation in the propofol maintenance group was lower than that of the maintenance group of sevoflurane ([RR= 0.57,95%CI (0.39,0.84)); The incidence of restlessness in intoxicated group was lower than that in sevoflurane inhalation anesthesia group [RR=0.16,95%CI (0.06,0.39)].
2. comparison of the revival characteristics of xenon and sevoflurane was included in 6 randomized controlled trials. A total of 449 patients with.Meta analysis showed that: 1. Compared with isoflurane, the opening time after xenon anesthesia was shorter [SMD=-1.07,95%CI (-1.31, -0.82)) (SMD: standardized mean number difference); the extubation time was shorter [SMD=-2.04,95%CI (-3.30, -0.78)); 5 minutes later Aldre There was no statistical difference in te ([SMD=3.34,95%CI (-0.49,6.76)). Compared with sevoflurane, the opening time of xenon was shorter [SMD=-1.54,95%CI (-2.00, -1.07)); the extubation time was shorter [SMD=-3.72,95%CI (-4.90, -2.55)); the recovery time was shorter than [SMD=-2.20,95%CI (-3.84, -0.56)]; .31, -0.82)] there was no significant difference in the incidence of PONV ([RR=1.26,95%CI (0.67, -2.38)].
research conclusion
The results of Meta analysis showed that: (1) the incidence of agitation in children after sevoflurane anesthesia was higher than that of propofol. Compared with sevoflurane, children's parents were more satisfied with propofol anesthesia. (2) compared to isoflurane and sevoflurane anaesthesia, xenon anaesthesia was rapid and the xenon and isoflurane anesthetized patients had no difference in Aldrete score; xenon gas. There is no difference between the incidence of PONV in sevoflurane anesthesia and the early recovery of cognitive ability after xenon anesthesia. Limited by the quantity and quality of the study, the clinical situation should be considered in all aspects of the children before choosing the way of anesthesia.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614.2

【参考文献】