内镜下粘膜剥离术采用全身麻醉与镇静的比较：一项系统性评价和meta分析的结果

内镜下粘膜剥离术采用全身麻醉与镇静的比较：一项系统性评价和meta分析的结果

贵州医科大学麻醉与心脏电生理课题组

翻译：柏雪

编辑：宋雨婷 

审校：曹莹

1、目的

内镜下粘膜剥离术(ESD)是一种内镜下治疗胃肠道肿瘤的方法。ESD 通常在镇静状态下进行。本试验假设运用全身麻醉(GA)可以改善ESD的结果。

2、方法

我们进行了一项系统性回顾和meta分析来比较GA和镇静在ESD中的作用。使用检索词“全身麻醉”、“镇静”和“内镜下黏膜剥离术”在Cochrane图书馆、EMBASE和MEDLINE上进行了系统地文献检索。纳入了比较GA和镇静在ESD中的原始文章。通过已验证的方法评估偏倚风险和证据水平。

3、结果

本综述已在PROSPERO(CRD42021275813) 中注册。初始文献检索共发现176篇文献，共纳入7篇文章（包括518名接受GA和495名接受镇静的患者）。与镇静相比，采用GA与行食管ESD的整体切除有较高相关性（RR 1.05；95% CI：1.00-1.10；I2 = 65%；P = 0.05）。在所有ESD手术中，采用GA的患者胃肠道穿孔率较低（RR 0.62；95% CI：0.21-1.82；I2 = 52%；P = 0.06）。GA患者术中氧饱和度降低和术后吸入性肺炎的发生率低于镇静患者。纳入的研究存在中度至高度偏倚风险，总体证据水平较低。

4、结论

GA对于ESD来说似乎是安全可行的，但在GA可以广泛用于ESD之前需要进行高质量的试验。

原始文献来源：

Choy-May Leung, Rex Wan-Hin Hui. Comparing general anaesthesia versus sedation for endoscopic submucosal dissection: results from a systematic review and meta-analysis. Anaesthesiology intensive therapy.

英文原文

Comparing general anaesthesia versus sedation for endoscopic submucosal dissection: results from a systematic review and meta-analysis

Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure for management of gastrointestinal tumours. ESD is usually performed under sedation.

However, the use of general anaesthesia (GA) has been hypothesised to improve ESD outcomes. We performed a systematic review and meta-analysis to compare GA against sedation in ESD. A systematic literature search was performed on Cochrane Library, EMBASE and MEDLINE using the terms “General Anaesthesia”, “Sedation” and “Endoscopic submucosal dissection”. Original articles comparing GA versus sedation in ESD were included. The risk of bias and level of evidence were assessed by validated methods.

This review is registered in PROSPERO (CRD42021275813). 176 articles were found in the initial literature search, and 7 articles (comprising 518 patients receiving GA and 495 receiving sedation) were included. Compared with sedation, GA was associated with higher en-bloc resection rates in oesophageal ESD (RR 1.05; 95% CI: 1.00–1.10; I2 = 65%; P = 0.05). GA patients also trended towards lower rates of gastrointestinal perforation in all ESD procedures (RR 0.62; 95% CI: 0.21–1.82; I2 = 52%; P = 0.06). Rates of intra- procedural desaturation and post-procedural aspiration pneumonia were lower in GA patients than in patients under sedation. The included studies had a moderate to high risk of bias, and the overall level of evidence was low. GA appears safe and feasible for ESD, yet high-quality trials will be required before GA can be regularly implemented for ESD.

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