椎管内阻滞对心脏事件高危患者行非心脏手术后心肌梗死影响的Meta分析

发布时间：2018-05-14 02:40

本文选题：椎管内阻滞 + 非心脏手术　；参考：《临床麻醉学杂志》2017年08期

【摘要】：目的采用Meta分析比较椎管内阻滞[包括硬膜外阻滞(epidural anesthesia,EA)和蛛网膜下腔阻滞(spinal anesthesia,SA)]复合全身麻醉(general anesthesia,GA)对非心脏手术后心肌梗死的影响。方法检索中文数据库(中国生物医学文献服务系统、中国知网、万方、维普)和英文数据库(Medline、PubMed、EBSCO、Springer、Ovid、Cochrane Library、Google scholar);收集椎管内阻滞对非心脏手术患者术后心肌梗死及死亡率影响的随机对照试验(RCT),并采用RevMan 5.3软件进行统计分析。结果共纳入10篇RCT(n=21 859)。Meta分析结果显示:EA复合GA与单纯GA非心脏手术术后7d内(OR=0.44,95%CI 0.13~1.46,P=0.18)和30d内(OR=1.49,95%CI 0.89~2.49,P=0.13)内心肌梗死发生率差异无统计学意义;EA复合GA与单纯GA术后30d内(OR=1.26,95%CI 0.84~1.88,P=0.26)全因死亡率差异无统计学意义。SA与GA术后7d内心肌梗死发生率(OR=1.14,95%CI 0.31~4.17,P=0.84)和术后30d内全因死亡率(OR=0.88,95%CI 0.43~1.79,P=0.73)差异无统计学意义。结论椎管内阻滞并未降低心脏事件高危患者行中高危非心脏手术后心肌梗死发生率及死亡率。
[Abstract]:Objective to compare the effects of intraspinal block (including epidural block (epidural anesthesia, EA) and subarachnoid block (spinal anesthesia, SA) (general anesthesia, GA) on myocardial infarction after non cardiac surgery by Meta analysis. Method retrieval Chinese database (Chinese biomedical literature service system, Chinese knowledge network, Wan Fang, VP) and English databases (Medline, PubMed, EBSCO, Springer, Ovid, Cochrane Library, Google scholar); a randomized controlled trial (RCT) for the effects of intraspinal block on postoperative myocardial infarction and mortality in non cardiac surgery patients (RCT), and the statistical analysis was carried out by RevMan 5.3 software. The results were included in 10 RCT (859) analysis. The results showed that there was no significant difference in the incidence of myocardial infarction in 7d (OR=0.44,95%CI 0.13~1.46, P=0.18) and 30d (OR=1.49,95%CI 0.89~2.49, P=0.13) after non cardiac surgery for EA combined with simple GA, and there was no significant difference in the mortality difference between GA and 30d (OR=1.49,95%CI 0.89~2.49, P=0.13). There was no statistically significant difference in the incidence of internal myocardial infarction (OR=1.14,95%CI 0.31~4.17, P=0.84) and all cause mortality (OR=0.88,95%CI 0.43~1.79, P=0.73) within 30d after the operation in 7d. Conclusion intraspinal block did not reduce the incidence and mortality of myocardial infarction in high-risk patients with high risk of heart events after high risk of non cardiac surgery.

【作者单位】：重庆市肿瘤研究所手术麻醉科;
【分类号】：R614

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