心脏或非心脏手术后麻醉深度和死亡率：随机对照试验的系统评价和Meta分析

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心脏或非心脏手术后麻醉深度和死亡率：随机对照试验的系统评价和Meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：柏雪  编辑：张中伟  审校：曹莹

目的：目前随机对照试验未能显示使用经过处理的脑电图 (pEEG) 来指导浅麻醉可以降低死亡率。我们对 pEEG 监测随机试验的死亡率数据进行了Meta分析，以评估 pEEG 引导的浅麻醉与深麻醉相比对 18 岁以上成人的所有保护作用的证据。

方法：我们的研究遵循系统评价和Meta分析（PRISMA）指南的首选报告项目。2022 年 2 月，我们在三个数据库（Cochrane CENTRAL、OVID Medline、EMBASE）中搜索了提供 30 天、90 天和/或 1 年或更长时间的死亡率数据的 pEEG 监测 RCT。

结果：我们纳入了来自 12 项 RCT 的 16 篇文章，共有 48 827 名参与者。当汇总所有研究时，我们观察到与深度麻醉相比，浅麻醉与深度麻醉没有统计学意义的降低（优势比 [OR] = 0.99；95% 置信区间 (CI)，0.92-1.08）。在分析 30 天、90 天、1 年或更长时间的死亡率时，该结果没有显著变化。我们观察到， pEEG 监测的较高pEEG 指数值（OR=0.89；95% CI，0.60-1.32），或无警报的低 pEEG 指数值（OR=1.02；95% CI，0.41–2.52）与常规护理相比并没有降低死亡率（OR=1.02；95% CI，0.89-1.18）。

结论：pEEG引导的浅麻醉似乎不会降低术后死亡的风险。由于缺乏合理的理由来解释为什么深度麻醉会增加死亡率，这阻碍了确定性临床试验的适当设计。

原始文献来源：Thomas Payne, Hannah Braithwaite，Tim McCulloch, et, al. Depth of anaesthesia and mortality after cardiac or noncardiac surgery: a systematic review and meta-analysis of randomised controlled trials. British Journal of Anaesthesia.

英文原文     

Depth of anaesthesia and mortality after cardiac or noncardiac surgery: a systematic review and meta-analysis of randomised controlled trials

Abstract

Background: 

Recent randomised controlled trials have failed to show a benefit in mortality by using processed electroencephalography (pEEG) to guide lighter anaesthesia. We performed a meta-analysis of mortality data from randomised trials of pEEG monitoring to assess the evidence of any protective effect of pEEG-guided light anaesthesia compared with deep anaesthesia in adults aged≥18 yr.

Methods: 

Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. In February 2022, we searched three databases (Cochrane CENTRAL, OVID Medline, EMBASE) for RCTs of pEEG monitoring that provided mortality data at 30 days, 90 days, and/or 1 yr or longer.

Results: 

We included 16 articles from 12 RCTs with 48 827 total participants. We observed no statistically significant mortality reduction with light anaesthesia compared with deep anaesthesia in patients aged≥18 yr when all studies were pooled (odds ratio [OR]=0.99; 95% confidence interval (CI), 0.92-1.08). This result did not change significantly when analysing mortality at 30 days, 90 days, 1 yr or longer. We observed no mortality benefit for pEEG monitoring compared with usual care (OR=1.02; 95% CI, 0.89-1.18), targeting higher pEEG index values compared with lower values (OR=0.89; 95% CI, 0.60-1.32), or low pEEG index value alerts compared with no alerts (OR=1.02; 95% CI, 0.41-2.52).

Conclusions: 

pEEG-guided lighter anaesthesia does not appear to reduce the risk of postoperative mortality. The absence of a plausible rationale for why deeper anaesthesia should increase mortality has hampered appropriate design of definitive clinical trials.