丙泊酚用于儿童核磁共振检查麻醉效果与安全性的系统评价

Propofol Used for Requiring Sedation in Children undergoing Magnetic Resonance Imaging:a Systematic Review for Anaesthesia Efficacy and Safety

目的:评价丙泊酚静脉麻醉用于儿童核磁共振检查的临床麻醉效果和安全性。方法:计算机检索国内外相关数据库文献资料,并辅以手工检索相关文献的参考文献目录,全面收集丙泊酚用于儿童核磁共振检查的麻醉效果的临床随机对照试验文献,由两名评价员独立筛选、提取资料并对其进行质量评价,分析总结丙泊酚的临床麻醉效应。结果:共纳入5篇文献(共529名患者,年龄范围是1～18岁),由于存在临床异质性(如对照药物与给药方法不同),未进行Meta分析,仅进行描述性分析;与右美托咪定或戊巴比妥等有效药物相比,丙泊酚用于儿童核磁共振检查的麻醉效果与安全性基本相同,苏醒时间更快,个别会出现低血压、呼吸抑制等不良反应;比较断续滴定法与持续维持法、麻醉达成后维持或不维持给药等方法,不同的丙泊酚给药方法均具有同等麻醉效果与安全性。结论:丙泊酚静脉麻醉用于儿童磁共振检查的优势在于复苏时间短,苏醒快;因个别病例存在呼吸抑制和血压降低的风险,需进行严密的生命体征监测;采用不同给药方法实施麻醉,麻醉效果与安全性相同,可结合实际情况选择使用。

Objective： To evaluate the efficacy and safety of propofol anesthesia for requiring sedation in children undergoing magnetic resonance imaging（MRI）. Method：The electronic bibliographic databases were searched to assemble the randomized controlled trials （RCTs） , and reference lists of relevant articles were reviewed for additional trials. Their data were extracted and evaluated by two reviewers independently. Result： Five articles were included （ a total of 529 cases, their ages ranging from 1 to 18 years）. Due to the significant clinical heterogeneity and inappropriate meta-analysis, the results of each study were individually presented. The results from 3 studies showed that propofol anesthesia used for sedation in children undergoing MRI had better an efficacy and safety as the same as the control active drugs, such as dexmedetomidine, pentobarbitals and sevoflurane, and then, in palinesthesia, had more shorter time to come around than dexmedetomidine or pentoharbital had, but propofol Can cause any respiratory depression and hypotension individually, compared to the based active drugs. The results from 2 studies demonstrated that different propofol medications of interrupt titration compared to continuing maintenance, or remaining intravenously compared to not remaining post anesthesia to reach, did not have any significant differences in efficacy and safety. Conclusion：Propofol can get the same efficacy and safety, more shorter palinesthesia time compared with other active drugs used in included trials for anesthesia in children undergoing MRI, but respiratory depression and hypotension may emerge during sedation individually, closely monitoring is necessary; Propofol medications included trials have the same outcome in efficacy and safety, could be used in MRI anesthesia clinically.