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| 依托咪酯和丙泊酚用于无痛结肠镜时麻醉效果的Meta分析 |
| A Meta analysis on anesthetic effects of etomidate and propofol in painless colonoscopy |
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| DOI：10.12089/jca.2021.11.013 |
| 中文关键词: 依托咪酯 丙泊酚 无痛结肠镜 Meta分析 |
| 英文关键词: Etomidate Propofol Painless colonoscopy Meta-analysis |
| 基金项目: |
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| 中文摘要: |
目的 通过Meta分析比较依托咪酯和丙泊酚用于无痛结肠镜时的麻醉效果和不良反应。
方法 系统的检索Cochrane图书馆、Pubmed、Embase、中国知网、维普、万方数据库，检索时间为建库至2021年1月，收集有关依托咪酯和丙泊酚用于无痛结肠镜时麻醉效果和不良反应的临床随机对照试验（RCT），同时追溯纳入文献的参考文献。依托咪酯组采用依托咪酯作为麻醉用药，复合或不复合其他镇痛药，丙泊酚组采用相同配伍的丙泊酚。对符合纳入标准的文献进行质量评价和资料提取，采用RevMan5.4软件进行Meta分析。
结果 共纳入13个RCT，1 352例患者。Meta分析显示：与丙泊酚比较，依托咪酯能明显增加血流动力学稳定性MAP（MD=15.53 mmHg，95％CI 12.26～18.80 mmHg）、HR（MD=6.02次/分， 95％CI 2.88～9.16次/分），降低注射痛发生率（OR=0.09，95％CI 0.04～0.23）、低血压发生率（OR=0.33，95％CI 0.23～0.48）、呼吸抑制发生率（OR=0.27， 95％CI 0.14～0.54）、低氧血症发生率（OR=0.27，95％CI 0.16～0.47），两者术毕苏醒时间差异无统计学意义（MD=0.74 min，95％CI -0.37～1.85 min），依托咪酯麻醉诱导后入睡时间明显延长（MD=0.01 min，95％CI 0.00～0.02 min），恶心呕吐的发生率（OR=3.48，95％CI 2.14～5.64）和肌痉挛的发生率（OR=8.08，95％CI 4.47～14.58）明显增加。
结论 对于无痛结肠镜，依托咪酯较丙泊酚对循环影响更小，手术后苏醒时间相当，注射痛、低血压、呼吸抑制及低氧血症等不良反应的发生率更低，但麻醉诱导后入睡时间更长，恶心呕吐及肌痉挛的发生率更高。 |
| 英文摘要: |
Objective To systematically review the anesthetic effects and adverse reactions of etomidate and propofol in painless colonoscopy through meta-analysis.
Methods Cochrane Library, Pubmed, Embase, CNKI, Weipu and Wanfang databases were searched for all randomized controlled trials (RCTs) from the year of construction to January 2021, focusing on the anesthetic efficacy and adverse reactions of etomidate and propofol in painless colonoscopy, and retrospectively included the references involved. Etomidate group used etomidate as the anesthetic drug with or without other analgesics, and propofol group used propofol in the same combination. The quality of the studies is evaluated by the method recommended by Cochrane collaboration, and the RevMan5.4 software was used for meta-analysis.
Results Thirteen RCTs involving 1 352 patients were included in our Meta-analysis. The results of meta-analysis showed that compared with propofol, the etomidate can significantly increase the hemodynamic stability MAP (MD = 15.53 mmHg, 95% CI 12.26-18.80 mmHg), HR (MD = 6.02 per minute, 95% CI 2.88-9.16 per minute), reduce the incidence of injection pain (OR = 0.09, 95% CI 0.04-0.23), the incidence of hypotension (OR = 0.33, 95% CI 0.23-0.48), incidence of respiratory depression (OR = 0.27, 95% CI 0.14-0.54), incidence of hypoxemia (OR = 0.27, 95%CI 0.16-0.47), there was no statistically difference in the time to wake up after surgery (MD = 0.74 min, 95% CI -0.37-1.85 min), and the time to fall asleep after anesthesia induction was significantly prolonged (MD = 0.01 min, 95%CI 0.00-0.02 min), and increased the incidence of nausea and vomiting (OR = 3.48, 95% CI 2.14-5.64) and the incidence of muscle spasms (OR = 8.08, 95% CI 4.47-14.58).
Conclusion For painless colonoscopy, etomidate has less impact on circulation than propofol, and the time to wake up after surgery is the same, and the incidence of adverse reactions such as injection pain, hypotension, respiratory depression, and hypoxemia is lower, but it takes longer to fall asleep after induction of anesthesia, and the incidence of nausea, vomiting and muscle spasms is higher. |
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