Narcotrend指导全身麻醉对患者麻醉苏醒时间影响的Meta分析

Meta- analysis of effect of Narcotrend-assisted general anesthesia on anesthesia recovery time

目的评估Narcotrend(NT)指导下的全身麻醉和临床经验指导下的全身麻醉对患者术毕苏醒时间的影响。方法检索Pub Med、Web of Science、EMBASE、Cochrane图书馆、CNKI、VIP、万方和中国优秀博硕士学位论文全文数据库,检索时限为1995年1月~2016年10月,纳入比较NT监测在全凭静脉麻醉中应用的临床随机对照研究。对纳入的文献进行质量评价与数据提取,采用Revman 5.0软件对数据进行Meta分析。结果共纳入12篇临床随机对照研究共871例患者,其中NT组438例,对照组433例。NT组患者的睁眼时间(WMD=-2.97,95%CI:-3.33^-2.62,P<0.00001)、定向力恢复时间(WMD=-4.08,95%CI:-7.77^-0.39,P=0.03)、拔管时间(WMD=-4.25,95%CI:-6.46^-2.03,P=0.0002)明显短于对照组;两组术后恶心呕吐发生率(RR=0.69,95%CI:0.39~1.21,P=0.19)及术中知晓率(RR=0.33,95%CI:0.04~3.17,P=0.34)差异无统计学意义。结论在全凭静脉麻醉中应用NT监测麻醉深度,可以缩短患者麻醉苏醒时间,但对术中知晓及术后恶心呕吐的发生率没有影响。

Objective To assess the effects of anesthesia recovery time of patiens with Narcotrend（NT）-assisted general anesthesia versus standard clinical practice. Methods A systematic search was performed using Pub MED, Web of Science, EMBASE, The Cochrane Library, CNKI, VIP, Wan Fang and CDMD from January 1995 to October 2016 to identify the randomized controlled trials（RCTs） studyings on the application of NT monitoring in the total intravenous anesthesia. The included trials were evaluated and date were extracted. Analysis was conducted using Revman 5.0software. Results A total of 871 patients in 12 eligible RCTs were identified in the Meta-analysis, 438 cases in NT group and 433 cases in control group. The combined data showed that the eye opening time（ WMD=-2.97, 95%CI：-3.33--2.62, P〈0.00001）, orientation recovery time（WMD=-4.08,95%CI：-7.77--0.39, P=0.03）, and extubation time（WMD=-4.25, 95%CI：-6.46--2.03, P=0.0002） in NT group were shorter than those in control group. Nevertheless, the incidence of postoperative nausea and vomiting（PONV）（RR=0.69, 95%CI： 0.39-1.21, P=0.19） and the incidence of intraoperative awareness（RR=0.33, 95%CI： 0.04-3.17, P=0.34） were not significant differences. Conclusion Compared with control group, NT monitoring in total intravenous can decrease anesthesia recovery time, but there was no difference between the two groups regarding the incidence of intraoperative awareness and PONV.