短效阿片类药物对全身麻醉期间眼压影响的比较：系统评价和网络Meta分析

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短效阿片类药物对全身麻醉期间眼压影响的比较：系统评价和网络Meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：吴学艳  编辑：马艳燕  审校：曹莹

0          1         背景      

眼压(IOP)对眼睛的健康至关重要；在麻醉期间，给予琥珀胆碱和气管插管与IOP升高有关，而短效阿片类药物可能会降低眼压。然而，在常用的短效阿片类药物中，药物的选择尚不清楚。

0          2         目的

本研究旨在评价芬太尼、舒芬太尼、阿芬太尼、瑞芬太尼对全麻患者琥珀胆碱给药后及气管插管后IOP的影响。

0          3         方法      

共检索五个数据库，纳入了比较短效阿片类药物并报告至少一种感兴趣的临床结果的随机对照试验（RCTs）分析共纳入9项RCTs，涉及357名患者。

04         结果      

与安慰剂组相比，瑞芬太尼(1µg/kg)能更有效的缓解应用琥珀胆碱后[平均眼压差(MD)，−3.64；可信区间(CI)，−5.47至−1.81]及气管插管后（MD，−9.71；CI，−11.91至−7.51)的IOP升高；瑞芬太尼(1µg/kg)在减弱琥珀胆碱治疗后IOP增加方面表现最好[累积排名曲线下面积(SUCRA)，0.91；熵归一化(NE)，0.47;气管插管后(SUCRA,0.89；NE，0.54)。

05           结论        

在IOP升高非常值得关注的情况下，瑞芬太尼(1µg/kg)应被考虑为首选药物。

06           原始文献来源        

Huang JY, Shih PC, Chen CT, et al. Effects of Short-Acting Opioids on Intraocular Pressure during General Anesthesia: Systematic Review and Network Meta-Analysis[J]. Pharmaceuticals (Basel). 2022 Aug 11;15(8):989. Doi: 10.33 90/ph 15080989.     

Effects of Short-Acting Opioids on Intraocular Pressure during General Anesthesia: Systematic Review and Network Meta-Analysis

Abstract

Intraocular pressure (IOP) is crucial to the well-being of eyes. During anesthesia, the administration of succinylcholine and endotracheal intubation are associated with an increase in IOP, which may be attenuated by short-acting opioids. However, the drug of choice among the commonly used short-acting opioids is unclear. This study aimed to evaluate the effects of fentanyl, sufentanil, alfentanil, and remifentanil on IOP measured after the administration of succinylcholine and after endotracheal intubation in patients undergoing general anesthesia. Five databases were searched. Randomized controlled trials (RCTs) that compared short-acting opioids and reported at least one of the clinical outcomes of interest were included. Nine RCTs with 357 patients were included. Remifentanil (1 μg kg-1) more effectively alleviated the increase in IOP than the placebo after the administration of succinylcholine [mean difference (MD) of IOP, -3.64; confidence interval (CI), -5.47 to -1.81 and after endotracheal intubation (MD, -9.71; CI, -11.91 to -7.51). Remifentanil (1 μg kg-1) ranked the best in terms of both attenuating the increase in IOP after the administration of succinylcholine [surface under the cumulative ranking curve (SUCRA), 0.91; normalized entropy (NE), 0.47; and after endotracheal intubation (SUCRA, 0.89; NE, 0.54) among all of the treatments. Remifentanil (1 μg kg-1) should be considered the drug of choice in the circumstances where increased IOP is a great concern.