老年人与青壮年人丙泊酚药动学的Meta分析

Meta-analysis of pharmacokinetics of propofoi in elderly and young adults

目的系统评价老年人与青壮年人丙泊酚药动学特征,为临床指导丙泊酚个体化用药提供循证医学证据。方法电子检索Medline、Ovid、Springer、CNKI、VIP、万方数据资源系统、中国生物医学文献数据库等,并辅以手工检索,收集所有老年人与青壮年人丙泊酚药动学的临床对照研究。使用Cochrane系统评价方法,评价纳入研究的方法学质量。用RevMan 4.2软件进行Meta分析。结果共检索到717篇英文文献和160篇中文文献,对上述文献进行筛选并除去重复文献,最后纳入5篇临床对照试验。Meta分析结果表明老年人丙泊酚V_c和CL均明显低于青壮年人[MD=-0.17,95%CI(-0.25,-0.09),P<0.0001;MD=-3.89,95%CI(-6.05,-1.73),P=0.000 41;两者丙泊酚半衰期无显著差异(P>0.05);老年人K_(10)、K_(12)均大于青壮年人[MD=0.07,95%CI(0.01,0.13),P=0.01;MD=0.05,95%CI(0.02,0.08),P=0.000 2],K_(21)和K_(13)无显著差异(P>0.05);1篇研究显示两者丙泊酚V_(dss)无显著差异(P>0.05),3篇研究合并结果显示,老年人AUC大于青壮年人[MD=24.56,95%CI(19.57,29.55),P<0.000 01]。结论老年人丙泊酚药动学特征不同于青壮年人。老年人丙泊酚V_c和CL低于青壮年人,AUC高于青壮年人。

AIM To systematically evaluate the propofol pharmacokinetics in the elderly and the young adults. METHODS Systematic computerized searches of the Medline, Ovid, Springer, CNKI, VIP, Wanfang database, CBM databases were conducted and supplemented by manual retrieval, to identify all clinical controlled trials （CCT） of propofol pharmacokinetics. The methodological qualities of included CCT were assessed, and the data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook. The RevMan 4.2 software was used for Meta-analysis. RESULTS A total of five CCT were included.Meta-analysis showed： the Vc and CL of propofol in the elderly were significantly less than the young adults （MD = -0.17, 95% CI： -0.25 to -0.09, P〈 0.000 1; MD = -3.89, 95%CI： -6.05 to -1.73, P= 0.000 4） . There were no differences in half lives of propofol. Compared with the young adults, the elderly could significantly increase the rate constants K10 and K12 （MD = 0.07, 95%CI： 0.01 to 0.13, P = 0.01 ; MD =0.05, 95%CI： 0.02 to 0.08, P = 0.000 2）. But there were no significant differences in K21 and K13 between the elderly and the young adults （P 〉 0.05）. One literature showed there was no significant difference in the Vdss （P 〉 0.05）, while another three articles showed the AUC in the elderly was significantly larger than the young adults （MD = 24.56, 95% CI： 19.57 to 29.55, P 〈 0.000 01 ）. CONCLUSION Limited current evidence showed the Vc and CL of propofol in the elderly were lower than the young adults, while the AUC was higher.