七氟烷对小儿短小手术麻醉效果的系统评价

Sevoflurane in the Anesthesia of Child Short Period Surgery: A Systematic Review

目的系统评价七氟烷与氯胺酮比较用于小儿短小手术麻醉时的效果和安全性。方法采用Cochrane系统评价方法,检索EMbase、PubMed、Cochrane图书馆、CNKI、VIP、CBMdisc、Ongoing Controlled Trial、会议论文等数据库(检索时间均从建库至2011年4月),查找七氟烷用于小儿短小手术的随机对照试验(RCT)和半随机对照试验(quasi-RCT),对符合纳入标准的临床研究进行资料提取和质量评价后,采用RevMan 5.1.1软件进行Meta分析。结果共纳入10个研究,合计600例患者。7个研究结果显示,七氟烷组的术中心率低于氯胺酮组[MD=–11.85,95%CI(–16.47,–7.23),P<0.00001];9个研究结果显示,七氟烷组的术后苏醒时间短于氯胺酮组[MD=–29.05,95%CI(–37.98,–20.12),P<0.00001];3个研究结果显示,七氟烷组的手术麻醉诱导时间短于氯胺酮组[MD=–208.45,95%CI(–359.22,–57.68),P=0.007];6个研究结果显示,七氟烷组与氯胺酮组对平均动脉压的影响差异无统计学意义[MD=–4.86,95%CI(–10.02,0.29),P=0.06];7个研究结果显示,七氟烷组不良反应发生例数较氯胺酮组少[Peto OR=0.29,95%CI(0.20,0.40),P<0.00001]。结论本系统评价结果表明,七氟烷在效果方面优于氯胺酮,同时能有效减少不良反应,为当前小儿短小手术提供了一种新的麻醉药物,在临床上有较好的应用前景。但由于目前临床对本手术多采用氯胺酮等药物进行麻醉,因此,进行更高质量更有针对性的临床研究,提供七氟烷与各种传统麻醉方案相互对比的重要数据,是下一步需要深入研究的问题。

Objective To assess the efficacy and safety of sevoflurane versus ketamine in the anesthesia of child short period surgery.Methods Such databases as EMbase,PubMed,The Cochrane Library,CNKI,VIP,CBMdisc,Ongoing Controlled Trial and Conference Articles were searched from their establishment to April 2011 to collect randomized controlled trials（RCTs） and the quasi-RCTs.The quality of those studies meeting the inclusive criteria was assessed,the data were extracted and the meta-analysis was conducted by using RevMan 5.1.1 software.Results Ten studies involving 600 participants were included.Seven studies showed that the intraoperative heart rate of the sevoflurane group was lower than that of the ketamine group（MD= –11.85,95%CI –16.47 to –7.23,P0.000 01）.Nine studies showed that the revival time of the sevoflurane group was shorter than that of the ketamine group（MD= –29.05,95%CI –37.98 to –20.12,P0.000 01）.Three studies showed that the anesthesia induction time of the sevoflurane group was shorter than that of the ketamine group（MD= –208.45,95%CI –359.22 to –57.68,P=0.007）.Six studies showed that the influence on mean arterial pressure（MAP） had no significante difference（MD= –4.86,95%CI –10.02 to 0.29,P=0.06）.Meanwhile,seven studies showed that the adverse events of the sevoflurane group were fewer than those of the ketamine group（Peto OR=0.29,95%CI 0.20 to 0.40,P0.000 01）.Conclusion The results of this system review show that sevoflurane is more effective than ketamine with fewer adverse reactions,and it provides a new choice for clinical anesthesia for child short period surgery.However,ketamine is still the main drug in clinical anesthesia for the child short period surgery at present,so high quality studies are needed for further clinical researches.