丙泊酚与七氟烷对老年患者非心脏手术后认知功能影响的Meta分析

Effect of Propofol or Sevoflurane on Postoperative Cognitive Function in Elderly Patients Undergoing Non-cardiac Surgery: A Meta-analysis

目的系统评价丙泊酚与七氟烷对老年患者非心脏手术后早期认知功能障碍(POCD)发生的影响。方法计算机检索Cochrane library、MEDLINE、EMBASE、Pubmed、中国生物医学文献数据库、中国知网、维普数据库和万方数据库中关于丙泊酚与七氟烷全身麻醉老年非心脏手术患者早期发生POCD的随机对照试验(RCT),检索时限均为建库至2016年6月。同时追溯纳入文献的参考文献。由3名独立研究者根据纳入标准,对纳入研究的RCT进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。统计学分析采用RevMan5.1版软件。结果共纳入14个RCT,老年非心脏手术患者790例。Meta分析结果显示:手术后丙泊酚组患者睁眼时间、拔管时间均短于七氟烷组[SMD_(睁眼)=-0.83,95%CI(-1.05,-0.61),P<0.05;SMD拔管=-0.85,95%CI(-1.09,-0.62),P<0.05];手术后1,3,6 h丙泊酚组与七氟烷组简易智能状态量表(MMSE)评分均降低,且丙泊酚组MMSE评分明显高于七氟烷组[SMD1 h=0.84,95%CI(0.61,1.08),P<0.05;SMD3 h=1.12,95%CI(0.86,1.38),P<0.05;SMD6 h=0.61,95%CI(0.40,0.82),P<0.05],手术后1 d丙泊酚组与七氟烷组MMSE评分差异无统计学意义[SMD1 d=0.14,95%CI(-0.03,0.31),P>0.05],手术后3 d丙泊酚组评分高于七氟烷组[SMD3 d=-0.32,95%CI(-0.56,-0.07),P<0.05],手术后7 d丙泊酚组与七氟烷组MMSE评分差异无统计学意义[SMD_(7d)=-0.18,95%CI(-0.51,0.15),P>0.05];手术后24 h,丙泊酚组患者POCD发生率明显高于七氟烷组[OR=0.35,95%CI(0.21,0.58),P<0.05]。结论丙泊酚与七氟烷麻醉,前者苏醒较快,拔管时间短,二者都会引起老年非心脏手术患者早期认知功能降低,但丙泊酚作用弱于七氟烷,更适合应用于老年患者的全身麻醉。

Objective To systematically review the influence of propofol orsevoflurane on postoperative cognitive dysfunction（POCD） in elderly patients undergoing non-cardiac surgery.Methods Eight databases including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Pubmed, CNKI, VIP, CBM and Wanfang Database were searched for randomized controlled trials （RCT） about the influence of propofol orsevoflurane on POCD in elderly patients from the time of database establishment to June, 2016.At the same time, the reference materials of included literature were retrieved manually.All data were selected and evaluated by three independent reviewers according to the inclusion and exclusion criterions.RevMan 5.1 was used for the data analysis.Results A total 14 trials were discovered involving 790 elderly patients undergoing non-cardiac surgery.The results of Meta-analysis showed that the eye opening time and extubation time in the propofol group were significant shorter than sevoflurane group[SMDeye opening=-0.83,95%CI（-1.05,-0.61）,P〈0.05;SMDextubation=-0.85,95%CI（-1.09,-0.62）,P〈0.05].The MMSE scores at 1,3 and 6 h respectivelyafter the operation were obviously higher than those of sevoflurane group[SMD1h =0.84,95%CI（0.61,1.08）,P〈0.05;SMD3 h=1.12,95%CI（0.86,1.38）,P〈0.05;SMD6h=0.61,95%CI（0.40,0.82）,P〈0.05].One day after the operation,the difference was not significant[SMD1d=0.14,95%CI（-0.03,0.31）,P〉0.05].Three days after the operation, the values returned to normal levels, and was still higher in propofol group than in sevoflurane group[SMD3d=-0.32,95%CI（-0.56,-0.07）,P〈0.05] until 7 d [SMD7d=-0.18,95%CI（-0.51,0.15）,P〉0.05].The odds ratio of POCD incidence between propofol and sevoflurane groups was 0.35 [95%CI（0.21,0.58）,P〈0.05].Conclusion Propofol may lead to shorter eye opening time and extubation time compared to sevoflurane in elderly patients undergoing non-cardiac surgery.Both groups may lead to POCD, while propofol is a better choice for elderly patients when choosing general anesthesia.