等比重与重比重布比卡因腰硬联合麻醉在剖宫产手术中应用的Meta分析

Application of hyperbaric and isobaric bupivacainecombined with spinal- epidural anesthesia in cesarean section: A Meta analysis

目的利用Meta分析方法对等比重与重比重布比卡因腰硬联合麻醉在剖宫产手术中的临床研究进行分析,并评价其效果。方法全面检索1998年1月至2013年11月间万方数据库和中国医学文献数据库已发表的国内外相关文献,最终进入系统评价的文献有9篇病例对照研究。应用Meta分析软件对各研究原始数据进行统计处理,计算标准化均数差及95%CI。结果在感觉阻滞起效时间、感觉阻滞最高平面时间、运动阻滞时间三方面,重比重布比卡因较等比重布比卡因起效快(P<0.05),但重比重布比卡因与等比重布比卡因在运动恢复时间上无明显差别(P>0.05)。结论不同比重的布比卡因均可获得满意的麻醉效果,重比重布比卡因起效迅速,适用于急诊剖宫产术;等比重布比卡因术中低血压发生率比重比重较低,适用于择期剖宫产术。

Objective To evaluate the Clinical effect on hyperbaric and isobaric bupivacaine combined with spinal-epidural anesthesia in cesarean section operation by Meta-analysis method. Methods Related literature that had been published in Wanfang datebase and China medicine literature database from January 1998 to November 2013 were retrieved comprehensively, and there were nine articles about case-control study which were selected into our study. Meta-analysis software RevMan5.1 was used to analyze raw data and to calculate the value of standardized mean difference（SMD） and 95% confidence interval（CI）. Results Onset time of sensory block, the highest level of sensory block time and motor block time in the hyperbaric bupivacaine group were shorter than isobaric bupivaeaine group （P 〈 0.05）. But there were no obviously statistical differences between two groups considering motor function recovery time （P 〉 0.05）. Conclusion Satisfactory anesthetic effect can be got when different proportion of bupivacaine was used. Hyperbaric bupivaeaine takes effects faster, which is suitable for emergent cesarean section; Isobaric bupivaeaine group has low incidence of intraoperative hypotension, Which is suitable for elective cesarean section.