椎管内麻醉与全身麻醉对关节置换术效果的Meta分析

发布时间：2018-05-23 16:19

本文选题：椎管内麻醉 + 全身麻醉　；参考：《临床麻醉学杂志》2017年01期

【摘要】：目的通过Meta分析的方法评价椎管内麻醉与全身麻醉对关节置换术的效果。方法计算机检索Pubmed、Web of Science、Cochrane Library、中国知网、中国生物医学数据库,检索中华系列杂志相关文献,收集所有评价椎管内麻醉与全身麻醉对关节置换术效果的随机对照试验(RCT),筛选出符合的文献,并严格评价纳入研究的方法学质量。统计学软件采用Cochrane协作网提供的RevMan 5.3。结果最终纳入21篇符合标准的RCT,共包含1 874例患者。Meta合并分析显示:与全身麻醉比较,椎管内麻醉可明显减少关节置换术术中出血量(WMD=-97.52ml,95%CI=-173.60~-21.44,P=0.01),明显降低关节置换术深静脉血栓发生率(RR=0.68,95%CI=0.48~0.95,P=0.02)、肺栓塞发生率(RR=0.58,95%CI=0.35~0.91,P=0.03)、术后恶心呕吐发生率(RR=0.74,95%CI=0.60~0.92,P=0.008)。亚组分析显示,未使用抗凝药时椎管内麻醉可明显降低深静脉血栓发生率(RR=0.51,95%CI=0.38~0.69,P0.001)和肺栓塞发生率(RR=0.34,95%CI=0.18~0.65,P=0.001)。结论椎管内麻醉在关节置换术中可有效改善患者术中情况,降低术后不良反应发生率。
[Abstract]:Objective to evaluate the effect of intraspinal anesthesia and general anesthesia on arthroplasty by Meta analysis. Methods the Pubmedus Web of Science Cochrane Library, China knowledge Web, China Biomedical Database, and related articles of Chinese series of journals were searched by computer. All the randomized controlled trials were collected to evaluate the effect of intraspinal anesthesia and general anesthesia on arthroplasty. The corresponding literatures were screened out and the methodological quality of the included study was evaluated strictly. The statistics software adopts the RevMan 5.3 provided by the Cochrane cooperation network. Results 21 RCTs that met the criteria were included, including 1 874 patients. Meta combined analysis showed that: compared with general anesthesia, Intraspinal anesthesia could significantly reduce the blood loss during arthroplasty, reduce the incidence of deep venous thrombosis in arthroplasty, reduce the incidence of deep vein thrombosis in arthroplasty, reduce the incidence of pulmonary embolism. The incidence of pulmonary embolism was RR0.5895CII 0.35 卤0.91P0.03, and the incidence of postoperative nausea and vomiting was RR0.74CI0.600.602P0. 008. Subgroup analysis showed that intraspinal anesthesia without anticoagulants could significantly reduce the incidence of deep venous thrombosis (RRN 0.51C95 CI 0.380.380.69 P0.001) and pulmonary embolism (RRN 0.34% 95% CI 0.18 0. 5% P0. 001). Conclusion Intra-spinal anesthesia can effectively improve the intraoperative condition and reduce the incidence of postoperative adverse reactions in arthroplasty.
【作者单位】：新疆石河子市人民医院麻醉科;解放军兰州总医院关节科;
【分类号】：R614

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