摘要
目的:系统评价(system review,SR)体外循环(cardiopulmonary bypass,CPB)下七氟醚(sevoflurane)麻醉对心脏手术患者的心肌保护作用,为心脏手术临床麻醉决策提供循证医学依据。方法:检索截至2008年10月Medline、CNKI、中国生物医学文献数据库等中CPB下七氟醚麻醉对心脏手术患者心肌保护作用的随机对照研究(random control trail,RCT)的相关公开发表文献,并辅以手工检索,对检索文献进行质量评价及筛选,采用RevMan4.2软件对最终纳入文献的研究结果进行meta分析。结果:根据文献纳入及排除标准,共有14篇RCT文献纳入本研究,包括七氟醚麻醉616例、全凭静脉麻醉(total intra-venous anesthesia,TIVA)610例。Meta分析结果表明:(1)与全凭静脉麻醉相比,七氟醚麻醉可有效增加术后心脏指数(WMD=0.20,95%CI0.08～0.32;P<0.01)和心排量(WMD=0.79,95%CI0.59～0.99;P<0.01);(2)七氟醚麻醉术后24h心肌肌钙蛋白I(cTnI)较全凭静脉麻醉明显降低(WMD=0.20,95%CI0.08～0.32;P<0.01);(3)与全凭静脉麻醉相比,七氟醚麻醉可有效减少术后机械通气时间(WMD=-0.68,95%CI-1.19～-0.17;P<0.01)和术后ICU留观时间(WMD=-15.83,95%CI-30.89～-0.78;P<0.01),但术后住院时间两者间无统计学差异;(4)七氟醚麻醉可有效降低术后正性肌力药物使用率(RR=0.57,95%CI0.42～0.76;P<0.01),但术后房颤发生率、心肌梗死率及病死率与全凭静脉麻醉组无统计学差异。结论:CPB下心脏手术中采用七氟醚麻醉具有一定的心肌保护作用。
Objective： To systematically review the cardioprotective of sevoflurane in patients undergoing heart surgery under cardiopulmonary bypass,so as to provide evidence for anesthesia decision of cardiac surgery. Methods： Trials about the cardioprotective effect of sevoflurane under CPB were collected through electronic search of Medline,CNKI, and CMBdisk （from the date of database establishment to October 2008） ; manual search was also conducted. Based on the inclusion and exclusion criteria,fourteen randomized-controlled trials were finally included in the present analysis. The details of the trial design, the characters of the subjects,and the results of the studies were reviewed and analyzed using RevMan 4.2 software. Results： The 14 trials involved 1 226 patients, including 616 receiving sevoflurane and 610 receiving total intravenous anesthesia （TIVA）. Compared with TIVA, our analysis showed the following results. （1） Cardiac function： sevoflurane significantly increased the postoperative cardio index （C1, P 〈 0. 01） and cardiac output （CO, P 〈 0. 01 ）. （2） Serum cTnI concentration at 24 h postoperation：sevoflurane group was significantly lower than that of TIVA group （P〈 0. 01）. （3）Sevoflurane significantly decreased the period of mechanical ventilation （P 〈0. 01） and the length of intensive care unit stay （P〈0. 01）, but the postoperative hospital stay was similar between the two groups. （4）The postoperative usage of inotropic agent was lower in sevoflurane group （ P 〈0. 01）. There were no significant differences in the mortality （P = 0. 59）, the incidence of atrial fibrillation （P = 0. 11）, and the myocardial infarction rate （P = 0. 11） between the two groups. Conclusion： Sevoflurane has cardioproteetive effect in patients undergoing heart surgery under CPB.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2009年第10期1166-1172,共7页
Academic Journal of Second Military Medical University
基金
第二军医大学教学研究与改革项目基金(JYC2008045)~~
