七氟烷吸入镇静较丙泊酚静脉镇静可缩短外科术后重症患者气管插管持续时间及总住院时间:一项537例患者的Meta分析

Sevoflurane inhalation sedation could shorten the duration of endotracheal intubation and the total length of hospital stay of critical patients after surgery as compared with propofol intravenous sedation: a Meta-analysis of 537 patients

目的对比分析七氟烷吸入镇静与丙泊酚静脉镇静对外科术后重症患者气管插管持续时间、重症医学科(ICU)住院时间及总住院时间的影响。方法检索中国知网(CNKI)、万方数据、美国国立医学图书馆PubMed、荷兰医学文摘Embase、Cochrane图书馆和科学网(WebofScience)数据库中有关七氟烷吸入镇静与丙泊酚静脉镇静对术后重症患者镇静持续时间、气管插管持续时间、ICU住院时间、总住院时间及不良反应发生率影响的随机对照临床试验(RCT),检索时限均为建库至2018年7月,同时追溯纳入文献的参考文献。由3名研究者独立筛选文献,并对纳入研究进行资料提取和质量评价,对符合质量标准的RCT进行Meta分析。结果最终纳入7项RCT研究,共537例患者,均为外科术后带气管导管转入ICU的患者;其中七氟烷组272例,丙泊酚组265例。纳入研究整体设计良好,质量较高。Meta分析结果显示:与丙泊酚镇静相比,七氟烷镇静患者气管插管持续时间明显缩短〔标准化均数差(SMD)=-0.60,95%可信区间(95%CI)=-0.88^-0.31,P<0.0001〕,总住院时间亦明显缩短(SMD=-0.36,95%CI=-0.61^-0.12,P=0.003),患者入ICU12~24h内心肌肌钙蛋白T(cTnT)明显降低(SMD=-0.61,95%CI=-0.85^-0.36,P<0.00001);而七氟烷镇静与丙泊酚镇静患者镇静持续时间(SMD=-0.07,95%CI=-0.29~0.15,P=0.52)、ICU住院时间(SMD=-0.19,95%CI=-0.39~0.01,P=0.06)、恶心呕吐发生率〔优势比(OR)=1.19,95%CI=0.61~2.32,P=0.61〕及谵妄发生率(OR=0.80,95%CI=0.34~1.90,P=0.62)比较差异均无统计学意义。结论七氟烷吸入镇静较丙泊酚静脉镇静能缩短外科术后重症患者气管插管持续时间及总住院时间,且具有较好的心肌保护作用;但本次Meta分析纳入文献数量较少,需进一步研究证实。

Objective To compare the influence of sevoflurane inhalation sedation and propofol intravenous sedation on duration of endotracheal intubation as well as the length of intensive care unit (ICU) stay and total length of hospital stay in postoperative critical patients. Methods Six databases including CNKI, Wanfang data, PubMed, Embase, Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) about the influence of sevoflurane inhalation sedation or propofol intravenous sedation on the sedation time, the duration of endotracheal intubation, the length of ICU stay, the total length of hospital stay and the adverse effects rate in postoperative critical patients from the time of database establishment to July 2018. At the same time, the reference materials of included literature were retrieved manually. All literatures were screened by three independent reviewers, and the data extraction and quality evaluation of the included studies were conducted. Meta-analysis was used for RCT that met the quality standards. Results A total of 7 RCT studies were enrolled involving 537 patients who were all transferred into ICU after surgery with trachea cannula. Among the patients, 272 received sevoflurane sedation while the other 265 received propofol sedation. All the included studies were well designed and of high quality. The results of Meta-analysis showed that compared with propofol sedation, sevoflurane sedation could significantly shorten the duration of endotracheal intubation [standardized mean difference (SMD) = -0.60, 95% confidence interval (95%CI) = -0.88 to -0.31, P < 0.000 1] and the total length of hospital stay (SMD = -0.36, 95%CI = -0.61 to -0.12, P = 0.003), and lower the cardiac troponin T (cTnT) within 12-24 hours after ICU admission (SMD = -0.61, 95%CI = -0.85 to -0.36, P < 0.000 01). There was no significant difference in the sedation time (SMD = -0.07, 95%CI = -0.29 to 0.15, P = 0.52), the length of ICU stay (SMD = -0.19, 95%CI = -0.39 to 0.01, P = 0.06), the incidence of nausea and vomiting [odds ratio (OR) = 1.19, 95%CI = 0.61 to 2.32, P = 0.61] or incidence of delirium (OR = 0.80, 95%CI = 0.34 to 1.90, P = 0.62) between sevoflurane group and propofol group. Conclusions Sevoflurane inhalation sedation may lead to shorter duration of endotracheal intubation and total length of hospital stay, and had better protection for myocardium as compared with propofol intravenous sedation. The above conclusions needed further study to confirm, due to the lack of literature enrolled in this Meta-analysis.