依托咪酯-芬太尼类药物在老年胃镜检查应用的Meta分析

目的 Meta分析依托咪酯和丙泊酚分别联合芬太尼类药物用于老年胃镜检查的麻醉效果及安全性。方法计算机检索Cochrane图书馆、Pub Med、Embase、中国生物医学文献数据库(CBM)、中国知网、维普资讯网和万方数据库等建库至2016年发表的关于依托咪酯-芬太尼类药物用于老年无痛胃镜术的随机对照试验(RCT),按照Jadad量表评价纳入研究的质量和提取资料,采用Rev Man 5.3软件进行统计分析。结果 11篇RCT(1 535例患者)纳入分析,依托咪酯组(E组)765例,丙泊酚组(P组)770例。依托咪酯组患者心率(HR)加权均数差(WMD)=2.25,95%CI(0.93,3.56),P=0.001]和平均动脉压(MAP)WMD=9.09,95%CI(7.60,10.57),P=0.000]的变化幅度较丙泊酚组小,发生低氧血症OR^=0.46,95%CI(0.32,0.65),P=0.000]的风险较丙泊酚组低,差异有统计学意义;不良反应的发生方面,依托咪酯组发生呼吸暂停OR^=0.26,95%CI(0.15,0.48),P=0.000]、注射痛OR^=0.02,95%CI(0.01,0.05),P=0.000]的风险较丙泊酚组低,发生恶心呕吐OR^=3.44,95%CI(2.03,5.84),P=0.000]、肌阵挛OR^=8.14,95%CI(4.18,15.87),P=0.000]的风险较丙泊酚组高,差异有统计学意义。结论依托咪酯联合芬太尼类药物用于老年无痛胃镜术能较好地保持循环系统稳定,是一种安全有效的麻醉方案。

Etomidate plus Fentanyl-class drugs applied in older patients undergoing gastroscopy: a meta-analysis*

Objective?To make a systematical review of the safety and efficacy of Etomidate plus Fentanyl-class drugs and Propofol plus Fentanyl-class drugs in older patients undergoing gastroscopy. ?Methods?We searched the Cochrane library, PubMed, Embase, China Biology Medicine (CBM), CNKI, VIP, Wanfang Database for all randomized controlled trials (RCTs) about the efficacy of Etomidate plus Fentanyl-class drugs(Fentanyl, Sufentanil, remifentanil) in older patients undergoing gastroscopy. The quality of the studies was evaluated by the method recommended by the Jadad scale. Meta-analysis was conducted using the Cochrane Collaboration’s RevMan 5.3 software.?Results?11 RCTs involving 1 535 patients were analyzed. Meta-analysis showed that patients in the Etomidate group had a lower heart rate Weighted Mean Difference (WMD)=2.25, 95%CI(0.93, 3.56), P = 0.001] and mean arterial pressure WMD = 9.09, 95%CI (7.60, 10.57), P = 0.000] fluctuation than whose of the Propofol group. The hypoxemia occurrence OR=0.46, 95% CI (0.32, 0.65), P = 0.000] in Etomidate group is also lower than which of the Propofol group. For side effects aspects, the risk of apneaOR=0.26, 95%CI(0.15, 0.48), P = 0.000] and injection pain OR= 0.02, 95%CI (0.01, 0.05), P = 0.000] in the Etomidate group is much lower than the Propofol group ,while the myoclonus OR=8.14, 95%CI (4.18, 15.87), P = 0.000], nausea and vomiting OR=3.44, 95%CI (2.03, 5.84), P = 0.000] were more incidental than the Propofol group.?Conclusion?Etomidate plus Fentanyl-class drugs can effectively maintain circulatory system for the old undergoing painless gastroscopy, demonstrated to be a safe and valid anesthesia method.