Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis.
Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis.
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吸入麻醉与全静脉麻醉对体外循环心脏手术患者脑保护作用的比较：系统评价和荟萃分析
DOI：
10.1136/bmjopen-2016-014629
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发表时间：
2017-10-11
期刊：
影响因子：
2.9
通讯作者：
Li H
中科院分区：
文献类型：
--
作者：
Chen F;Duan G;Wu Z;Zuo Z;Li H
目的体外循环（CPB）心脏手术后神经功能障碍是一种严重的并发症，吸入麻醉和全凭静脉麻醉（TIVA）对CPB患者的脑保护作用不同。因此，我们进行了系统的文献综述和荟萃分析，比较吸入麻醉和TIVA的神经保护作用。设计检索PubMed、EMBASE、Science Direct/Elsevier、中国知网和科克伦图书馆，截至2016年8月，我们选择了相关的随机对照试验进行荟萃分析。结果共检索到1485篇文献。在排除重复文章并筛选标题和摘要后，445项研究可能合格。在应用排除标准（全文报告为摘要、综述文章、无对照病例、缺乏结局数据等）后，选择了13项研究进行综述。我们的结果表明，吸入麻醉组与S100 B水平相关的主要结局在CPB后和术后24小时显著低于TIVA组（加权平均差（WMD）; 95% CI（CI）：分别为-0.41（-0.81至-0.01），-0.32（-0.59至-0.05））。次要结局变量中，吸入麻醉组术后24小时简易精神状态检查评分明显高于TIVA组（WMD（95% CI）：1.87（0.82 ~ 2.92）），但动静脉氧含量差、脑氧摄取率和颈静脉球静脉血氧饱和度无显著性差异在CPB期间冷却和复温时进行评估。结论吸入麻醉对体外循环心脏手术患者的脑保护作用优于全凭静脉麻醉，提示吸入麻醉可能更适用于体外循环心脏手术患者。
Objective Neurological dysfunction remains a devastating postoperative complication in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), and previous studies have shown that inhalation anaesthesia and total intravenous anaesthesia (TIVA) may produce different degrees of cerebral protection in these patients. Therefore, we conducted a systematic literature review and meta-analysis to compare the neuroprotective effects of inhalation anaesthesia and TIVA. Design Searching in PubMed, EMBASE, Science Direct/Elsevier, China National Knowledge Infrastructure and Cochrane Library up to August 2016, we selected related randomised controlled trials for this meta-analysis. Results A total of 1485 studies were identified. After eliminating duplicate articles and screening titles and abstracts, 445 studies were potentially eligible. After applying exclusion criteria (full texts reported as abstracts, review article, no control case, lack of outcome data and so on), 13 studies were selected for review. Our results demonstrated that the primary outcome related to S100B level in the inhalation anaesthesia group was significantly lower than in the TIVA group after CPB and 24 hours postoperatively (weighted mean difference (WMD); 95% CI (CI): −0.41(–0.81 to –0.01), −0.32 (−0.59 to −0.05), respectively). Among secondary outcome variables, mini-mental state examination scores of the inhalation anaesthesia group were significantly higher than those of the TIVA group 24 hours after operation (WMD (95% CI): 1.87 (0.82 to 2.92)), but no significant difference was found in arteriovenous oxygen content difference, cerebral oxygen extraction ratio and jugular bulb venous oxygen saturation, which were assessed at cooling and rewarming during CPB. Conclusion This study demonstrates that anaesthesia with volatile agents appears to provide better cerebral protection than TIVA for patients undergoing cardiac surgery with CPB, suggesting that inhalation anaesthesia may be more suitable for patients undergoing cardiac surgery.
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DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
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作者：
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2012-06-01
影响因子：
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Pasternak, Kazimierz
DOI：
10.1152/ajprenal.00290.2007
发表时间：
2007-12-01
影响因子：
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