针灸复合全身麻醉干预麻醉药用量的系统评价和Meta分析

Acupuncture Combined General Anesthesia on Dosage of Anesthetic:A Systematic Review and Meta-analysis

目的系统评价针灸复合麻醉对术中麻醉药使用量、苏醒时间、心率和平均动脉压的干预效应。方法由2人按制定的检索策略独立对7个电子数据库进行文献检索,以临床研究为单位,辅以手工检索相关文献;按研究纳入和排除标准筛选符合要求针灸辅助麻醉临床试验;根据Cochrane Handbook指导2人独立使用RevMan对每个符合纳入标准的临床试验进行偏倚风险和文献质量评估,并提取纳入研究的对象、方法和结果等资料;选取术中维持一定麻醉深度所使用的麻醉药品总量作为主要指标,术中心率和平均动脉压及术后苏醒时间为次要指标,条件符合时采取Meta分析。结果最终纳入12项研究,包括979名患者,静脉麻醉药丙泊酚用量均数差值(MD)和95%置信区间(CI)为-59.29[-91.92,-26.67];吸入麻醉药用量标准化均数差值(SMD)和95%CI为-2.34[-3.60,-1.09];苏醒时间MD和95%CI为-4.31[-4.52,-4.10];全麻过程中各时间点心率和平均动脉压95%CI均跨越无效线。结论针灸复合全身麻醉与常规全身麻醉相比,能减少麻醉药品使用量和缩短麻醉苏醒时间,对心率和平均动脉压无明显影响。

Objective This paper presents a systematic review and meta-analysis of acupuncture combined general anesthesia. Methods Systematic literature searches of 7 electronic databases were performed from inception to December 2013 by two investigators. We included randomized controlled trials that evaluated the effects of acupuncture compared with a control（routine procedure） or a sham intervention in patients undergoing general anesthesia. Two reviewers selected eligible studies and evaluated the risk of bias and the quality of the acupuncture intervention. Information on methods, participants, interventions, and outcomes was extracted. The total consumption of anesthetics during surgery was selected as the primary index. Meta-analysis of heart rate, mean arterial pressure and anesthetic recovery time was performed using random or fixed effects modeling. Results Twelve trials that included 979 patients who received general anesthesia met the inclusion criteria. Results of pooled analyses indicated that compared with general anesthesia alone, acupuncture assistance significantly reduced the total dose of anesthetics needed （mean difference [95%CI], propofol （mg）,-59. 29 [-91. 92, -26. 67], inhalational anesthetic （MAC）-2. 34 [-3. 60, -1. 09] and the anesthetic recovery time （min）-4. 31 [-4. 52, -4. 10], while no significant difference on heart rate and mean arterial pressure. Conclusion Compared with routine general anesthesia alone, acupuncture assistance reduces the dose of anesthetics and shortens anesthetic recovery time, shows no effect on heart rate and mean arterial pressure.