【罂粟摘要】丙泊酚与七氟烷用于儿童全身麻醉安全性的比较:一项随机对照试验的Meta分析

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丙泊酚与七氟烷用于儿童全身麻醉安全性的比较:一项随机对照试验的Meta分析

  无尽夏   Endless Summer    

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

背景:丙泊酚和七氟烷是儿科手术中最常用的麻醉药；躁动、术后恶心呕吐及术后疼痛是全麻药物主要不良反应；许多临床研究比较了丙泊酚和七氟烷在儿科手术中的安全性，但结果存在争议。

目的:评价丙泊酚与七氟烷用于儿童全身麻醉的安全性。

方法:检索PubMed、Embase、Cochrane Library、CNKI、万方数据、维普数据等数据库收集相关文章；试验严格按照之前确定的纳入和排除标准进行选择；采用RevMan 5.3软件进行meta分析。

结果:纳入20项随机对照试验，共招募1550名全麻患儿，总体方法学质量为中低水平；分析表明，与七氟烷麻醉相比，丙泊酚麻醉显著降低了躁动(OR=4.99, 95% CI, 3.67–6.80; P<0.00001)、术后恶心、呕吐(OR=1.91, 95% CI,1.27–2.87; P=0.002)和术后疼痛的发生率(OR =1.72, 95% CI, 1.11–2.64; P=0.01)；然而，七氟烷组患儿睁眼时间(MD=−2.58, 95% CI, −2.97– −2.19; P<0.00001)和拔管时间(MD= −1.42, 95%CI, −1.81– −1.02; P<0.00001)明显短于丙泊酚组。

结论:与七氟烷麻醉相比，接受丙泊酚麻醉的儿童出现躁动、术后恶心呕吐及术后疼痛的风险较低；但接受七氟烷麻醉儿童的恢复速度略快于接受异丙酚麻醉的儿童。考虑到纳入研究的局限性，更好的方法学质量和大量的对照试验有望进一步量化丙泊酚和七氟烷用于儿童全身麻醉的安全性。

原始文献来源:Zhao Y, Qin F, Liu Y,et al. The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials[J]. Front Surg. 2022 Jun 22;9:924647. DOI: 10.3389/fsurg.2022.924647.

0   1      英文原文     

The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials

Background: Propofol and sevoflurane are the most used anesthetics for pediatric surgery. Emergence agitation, postoperative nausea and vomiting and postoperative pain are the primary adverse effect of these general anesthetics. Many clinical studies had compared the safety of propofol and sevoflurane in pediatric surgery, but the results were controversial.

Objectives: To evaluate the evidence surrounding the safety of propofol versus sevoflurane for general anesthesia in children.

Methods: Databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Vip Data were searched to collect relevant articles. Trials were strictly selected according to previously defined inclusion and exclusion criteria. RevMan 5.3 software was used for meta-analyses.

Results: Twenty randomized controlled trials recruiting 1,550 children for general anesthesia were included, with overall low-moderate methodological quality. There was evidence that compared with sevoflurane anesthesia, propofol anesthesia significantly decreased the incidence of emergence agitation (OR = 4.99, 95% CI, 3.67-6.80; P < 0.00001), postoperative nausea and vomiting (OR = 1.91, 95% CI, 1.27-2.87; P = 0.002) and postoperative pain (OR = 1.72, 95% CI, 1.11-2.64; P = 0.01) in children. However, patients who received sevoflurane tended to have shorter times to eye opening (MD = -2.58, 95% CI, -2.97- -2.19; P < 0.00001) and times to extubation (MD = -1.42, 95% CI, -1.81- -1.02; P < 0.00001).

Conclusions: This review reveals that the children who received propofol anesthesia had the lower risks of emergence agitation, postoperative nausea and vomiting and postoperative pain when compared with sevoflurane anesthesia. But the children who received sevoflurane recovered slightly faster than those received propofol. Considering the limitations of the included studies, better methodological quality and large controlled trials are expected to further quantify the safety of propofol and sevoflurane for general anesthesia in children.

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