丙泊酚用于胃肠镜检查的快速卫生技术评估

Propofol for Sedation During Gastrointestinal Endoscopy:A Rapid Health Technology Assessment

目的:快速评估丙泊酚用于胃肠镜检查的有效性、安全性和经济性,为其临床合理应用提供循证参考。方法:系统检索Pub Med、EMBase、the Cochrane Library、中国知网、万方数据库和中国生物医学文献数据库等数据库以及卫生技术评估(health technology assessment,HTA)相关网站、数据库,纳入丙泊酚对比安慰剂或其他传统麻醉药用于胃肠镜检查的HTA报告、系统评价/荟萃分析(Meta分析)及药物经济学研究。由2名研究者分别依照纳入标准和排除标准对文献进行筛选、数据提取与汇总,并使用多系统评价评估问卷(assessment of multiple sys-tematic reviews,AMSTAR)量表、卫生经济学评价报告标准共识(consolidated health economic evaluation reporting standards,CHEERS)量表对文献进行评价,采用定性描述的方法对研究结果进行汇总分析。结果:共纳入12篇系统评价/Meta分析和2篇药物经济学研究,未检索到相关HTA报告。汇总结果显示,与安慰剂或其他传统麻醉药相比,使用丙泊酚用于胃肠镜检查时,患者出院时间更早、恢复清醒更快、满意率更高,且不增加心肺不良反应风险,但会增加注射部位疼痛,且经济成本较高。结论:丙泊酚用于无痛胃肠镜检查具有良好的有效性和安全性,但经济性欠佳,有待进一步论证。

OBJECTIVE:To rapidly evaluate the efficacy,safety and economy of propofol in gastrointestinal endoscopy,so as to provide evidence-based reference for its clinical rational application.METHODS:Pub Med,EMBase,the Cochrane Library,CNKI,Wanfang database,CBM and the websites and databases related to health technology assessment(HTA)were systematically searched.HTA reports,systematic review/Meta-analysis and pharmacoeconomic studies related to propofol and placebo or other traditional sedations for gastrointestinal endoscopy were included.According to the inclusion and exclusion criteria,two reviewers independently screened the literature,extracted and summarized the data,evaluated the literature with assessment of multiple systematic reviews(AMSTAR)and consolidated health economic evaluation reporting standards(CHEERS),and analyzed the research results with qualitative description method.RESULTS:Totally 12 systematic reviews/Meta-analysis and 2 pharmacoeconomic studies were included,and no relevant HTA report was retrieved.The results showed that compared with the control group,propofol used in gastrointestinal endoscopy had earlier discharge time,faster recovery,higher satisfaction rate and did not increase the risk of cardiopulmonary adverse drug reactions,but it would increase the injection site pain,and the economic cost was higher.CONCLUSIONS:Propofol has good efficacy and safety in painless gastrointestinal endoscopy,yet its economic performance is poor,which needs to be further demonstrated.