使用四种药物组合进行麻醉诱导对眼科手术中喉罩插入时血液动力学变化影响的比较研究

本文由“罂粟花"授权转载

使用 "丙泊酚"、"依托咪酯-丙泊酚"、"硫喷妥 "和 "咪达唑仑-硫喷妥 "四种药物组合进行麻醉诱导对眼科手术中喉罩插入时血液动力学变化影响的比较研究

贵州医科大学     麻醉与心脏电生理课题组

翻译：严旭 编辑：陈锐  审核：曹莹

罂 粟 摘 要 

摘要：

背景：本研究旨在比较四种麻醉诱导药物（硫喷妥、丙泊酚、咪达唑仑-硫喷妥和依托咪酯-丙泊酚）对眼科手术中插入喉罩（LMA）期间的心血管反应的影响。

方法：本临床试验研究包括128名候选眼科手术的患者，分为四组。第一组的病人被给予咪达唑仑（0.04毫克/千克）与硫喷妥（2.5毫克/千克）的组合（T+M组）。我们对第二组（P组）的病人单独施用丙泊酚（2.5毫克/千克）。第三组接受依托咪酯（0.1毫克/千克）与丙泊酚（1毫克/千克）的组合（ET + P组），第四组的患者单独接受硫喷妥药物（5毫克/千克）（T组）。然后，评估患者麻醉前血流动力学参数的稳定性，并在麻醉后立即LMA放置后1、3、5分钟进行比较。

结果：四组之间在氧饱和度水平的变化上没有明显的差异（P>0.05）。此外，在5分钟内，T+M组和T组的收缩压和舒张压随时间下降的差异并不明显（P>0.05）。此外，这两组的稳定性高于其他两组（P＜0.05），最不稳定的一组是P组，P组的脉率变化有统计学意义（P＜0.05）。诱导化合物，促进LMA的插入，并具有更高的血液动力学稳定性。

结论：根据目前的研究结果，与单用丙泊酚、丙泊酚和依托咪酯以及单用硫喷妥相比，硫喷妥和咪达唑仑可作为有效的。

原始文献来源：Shetabi H, Montazeri K, Ghoodjani Y. A Comparative Study of the Effect of Anesthesia Induction with the Use of Four Drug Combinations Including “Propofol,” “Etomidate-Propofol,” “Thiopental,” and “Midazolam-Thiopental” on Hemodynamic Changes during the Insertion of Laryngeal Mask in Eye Surgery[J]. Advanced biomedical research, 2022.

英文原文

A Comparative Study of the Effect of Anesthesia Induction with the Use of Four Drug Combinations Including “Propofol,” “Etomidate-Propofol,” “Thiopental,” and “Midazolam-Thiopental” on Hemodynamic Changes during the Insertion of Laryngeal Mask in Eye Surgery

Aims

Our objective was to conduct a systematic review and meta- analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures.

Methods

A structured search of MEDLINE, EMBASE, the online archives of Bone & Joint Publishing, and CENTRAL databases from inception until 28 July 2021 was performed. Randomized, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture nonunion, or chondral defects were excluded. Outcome data were assessed using the Risk of Bias 2 (ROB2) framework and synthesized in random- effect meta- analysis. The Preferred Reported Items for Systematic Review and Meta- Analyses guidance was followed throughout.

Results 

Six studies involving 353 fractures were identified from 3,078 records. Following ROB2 assessment, five studies (representing 338 fractures) were appropriate for meta- analysis. Primary outcomes showed non- significant reductions in articular depression at immediate postoperative (mean difference -0.45 mm, p = 0.25, 95%confidence interval (CI) -1.21 to 0. I2 = 0%) and long- term (> six months, standard mean difference -0.56, p = 0.09, 95% CI -1.20 to 0.08, I2 = 73%) follow- up in synthetic bone grafts. Secondary outcomes included mechanical alignment, limb functionality, and defect site pain at long- term follow- up, perioperative blood loss, duration of surgery, occurrence of surgical site infections, and secondary surgery. Mean blood loss was lower (90.08 ml, p < 0.001, 95% CI 41.49 to 138.67) and surgery was shorter (16.17 minutes, p = 0.04, 95% CI 0.39 to 31.94) in synthetic treatment groups. All other secondary measures were statistically comparable.

Conclusion

All studies reported similar methodologies and patient populations; however, imprecision may have arisen through performance variation. These findings supersede previous literature and indicate that, despite perceived biological advantages, autologous bone grafting does not demonstrate superiority to synthetic grafts. When selecting a void filler, surgeons should consider patient comorbidity, environmental and societal factors in provision, and perioperative and postoperative care provision.

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