氙气对比异氟醚、氙气对比七氟醚麻醉后苏醒特征的系统评价

Postoperative Recovery Characteristics after Xenon, Isoflurane or Sevoflurane Anesthesia: A Systematic Review

目的用Meta的方法评价氙气对比异氟醚、氙气对比七氟醚麻醉后患者苏醒时间、术后恶心呕吐发生率以及认知功能等特征。方法计算机检索Pub Med、EMBASE、SCI、The Cochrane图书馆、CBM、CNKI、万方数据库和维普数据库,纳入比较氙气对比异氟醚、氙气对比七氟醚麻醉后苏醒特征的随机对照试验,使用Cochrane Handbook 5.0推荐的"偏倚风险评估"工具对纳入研究进行方法学质量评价,用Rev Man5.1.7软件进行Meta分析。结果纳入6个随机对照试验,共计449例患者。Meta分析结果显示:1与异氟醚相比,氙气麻醉后睁眼时间较短[标准化均数差-1.49,95%可信区间(-2.31,-0.68)];氙气麻醉后拔管时间较短[标准化均数差-2.04,95%可信区间(-3.30,-0.78)];氙气麻醉恢复指数较大[标准化均数差1.20,95%可信区间(0.52,1.87)];氙气和异氟醚麻醉苏醒5分钟后Aldrete评分差异无统计学意义[标准化均数差3.14,95%可信区间(-0.49,6.76)]。2与七氟醚相比,氙气麻醉后睁眼时间较短[标准化均数差-1.54,95%可信区间(-2.00,-1.07)];氙气麻醉后拔管时间较短[标准化均数差-1.80,95%可信区间(-2.39,-1.20)];氙气麻醉后恢复方向感时间较短[标准化均数差-2.20,95%可信区间(-3.84,-0.56)];氙气麻醉后恢复倒数数字时间较短[标准化均数差-2.19,95%可信区间(-2.87,-1.51)];氙气对比七氟醚麻醉术后恶心呕吐发生率差异无统计学意义[相对危险度1.26,95%可信区间(0.66,2.39)]。结论与异氟醚和七氟醚相比,氙气麻醉后苏醒迅速;氙气麻醉与异氟醚相比,患者的Aldrete评分没有区别;氙气麻醉与七氟醚相比,患者术后恶心呕吐发生率没有差异,氙气麻醉术后认知能力恢复较早。

Objective To evaluate the emergence time, the incidence rate of postoperative nausea or vomiting（PONV）, and the cognitive function after Xenon anesthesia vs. Isoflurane or Xenon vs. Sevoflurane. Methods Pub Med, EMBASE, Web of Science, The Cochrane Library, CBM, CNKI, Wanfang database, and VIP database were used to search the randomized controlled trial（RCT） involving postoperative recovery characteristics after Xenon or Isoflurane anesthesia and Xenon or Sevoflurane anesthesia; the correlated references were also searched for complement. All included RCTs were assessed and analyzed according to the standards of Cochrane systematic review by using Rev Man 5.1.7. Results A total of 6 RCTs involving 449 patients were included. Meta-analysis showed that the eye-opening time [SMD =-1.49,95% CI（-2.31,-0.68） ] and the extubation time [SMD =-2.04,95% CI（-3. 30,- 0.78）] after Xenon anesthesia were shorter than those of Isoflurane; the recovery index [SMD =1.20,95% CI（0.52,1.87）] after Xenon anesthesia were higher than those of Isoflurane; and there was no difference about the Aldrete score 5 min after extubation between Xenon and Isoflurane [SMD=3.14,95%CI（-0.49,6.76）]. In addition, the results also showed that the eye- opening time [ SMD =- 1. 54, 95 % CI（- 2. 00,- 1. 07） ], the extubation time [ SMD =- 1. 80,95 % CI（- 2. 39,- 1.20） ], time to regain orientation [ SMD =-2.20,95% CI（-3.84,-0.56） ] and time to counting backward [ SMD =-2.19,95%CI（-2.87,-1.51）] were shorter after Xenon anesthesia; and there was no difference about the incidence of PONV between Xenon and Sevoflurane anesthesia [RR =1.26,95% CI（0.66,2.39）]. Conclusion Current evidence suggests that the emergence time was shorter after Xenon anesthesia compared with Isoflurane and Sevoflurane; and there was no significant difference about the Aldrete score after 5 min and the incidence of PONV between Xenon, Isoflurane and Sevoflurane anesthesia. The cognitive function was recovered earlier after Xenon anesthesia than that of Sevoflurane.