瑞马唑仑与丙泊酚应用于无痛胃肠镜安全性及有效性Meta分析

Meta analysis of the safety and efficacy of remimazolam and propofol in painless gastrointestinal endoscopy

目的:分析瑞马唑仑与丙泊酚应用于无痛胃肠镜的安全性及有效性。方法:对考克兰图书馆(Cochrane Library)、中国知网(CNKI)、中国生物医学文献服务系统(SinoMed)、维普中文期刊全文数据库(VIP)、万方数据知识服务平台(Wanfang Data)、PubMed文献数据库、Embase数据库等进行检索,纳入比较瑞马唑仑与丙泊酚应用于无痛胃肠镜的随机对照文献资料,搜索日期为建库至2022年2月,采用Rev Man 5.4统计学软件进行处理。结果:纳入14项研究,共计1808例。Meta分析结果显示,与丙泊酚相比,瑞马唑仑用于无痛胃肠镜有更稳定的平均动脉压(MD=10.05,95%CI:3.93-16.18,P=0.001)和心率(MD=5.1,95%CI:0.43-9.76,P=0.03),更低的低血压发生率(OR=0.25,95%CI:0.19-0.32,P<0.00001)、呼吸抑制发生率(OR=0.18,95%CI:0.12-0.29,P<0.00001)和注射痛发生率(OR=0.02,95%CI:0.01-0.05,P<0.00001),更短的苏醒时间(MD=-1.65,95%CI:-2.54--0.76,P=0.0003)和离室时间(MD=-4.30,95%CI:-8.46--0.13,P=0.04),而镇静成功率(OR=0.12,95%CI:0.02-0.99,P=0.05)和入睡时间(MD=9.29,95%CI:-0.24-18.81,P=0.06)比较差异均无统计学意义。结论:相比于丙泊酚,瑞马唑仑用于无痛胃肠镜检查,血流动力学更稳定,苏醒时间和离室时间更短,注射痛、低血压、呼吸抑制发生率更低,麻醉诱导的入睡时间和镇静成功率相当。

Objective:To evaluate the safety and efficacy of remimazolam and propofol in painless gastrointestinal endoscopy.Methods:The Cochrane Library,CNKI,SinoMed,VIP,Wanfang Data,PubMed and Embase databases were searched,and the randomized controlled literature comparing rimazole and propofol in painless gastroenteroscopy was included.The search date was from the establishment of the databases to February 2022,and the Rev Man 5.4 software was used for statistical analyses.Results:14 studies and a total of 1808 cases were included.Meta analysis showed that compared with propofol,remazolam had more stable mean arterial pressure(MD=10.05,95%CI:3.93 to 16.18,P=0.001)and heart rate(MD=5.1,95%CI:0.43 to 9.76,P=0.03),lower incidence of hypotension(OR=0.25,95%CI:0.19 to 0.32,P<0.00001),respiratory depression(OR=0.18,95%CI:0.12 to 0.29,P<0.00001)and injection pain(OR=0.02,95%CI:0.01 to 0.05,P<0.00001),shorter wake-up time(MD=-1.65,95%CI:-2.54 to 0.76,P=0.0003)and ventricular separation time(MD=-4.30,95%CI:-8.46 to-0.13,P=0.04),but there was no significant difference in sedation success rate(OR=0.12,95%CI:0.02 to 0.99,P=0.05)and sleep onset time(MD=9.29,95%CI:-0.24 to 18.81,P=0.06).Conclusion:Compared with propofol,remazolam for painless gastroenteroscopy has more stable hemodynamics,shorter wake-up time and ventricular separation time,lower incidence of injection pain,hypotension and respiratory depression,and the sleep onset time and success rate of the induction of anesthesia are the same.