瑞马唑仑联合艾司氯胺酮静脉麻醉在内镜逆行胰胆管造影术中应用效果的meta分析

Meta-analysis of the effect of intravenous anesthesia with remimazolam and esketamine in endoscopic retrograde cholangiopancreatography

目的:系统评价瑞马唑仑联合艾司氯胺酮静脉麻醉在内镜逆行胰胆管造影术中应用效果。方法:计算机检索PubMed、Embase、Cochrane Library、Web of Science、万方、知网和维普数据库,系统搜索瑞马唑仑联合艾司氯胺酮在内镜下逆行胰胆管造影术中应用的随机对照实验(RCTs),检索时间区间为数据库建库至2022年10月。利用Revman5.4软件进行meta分析。结果:共纳入4篇符合纳入标准的文献,囊括350例患者。本次meta分析结果显示,与对照组相比,干预组麻醉后的心率、平均动脉压、血氧饱和度和呼吸频率更高,术中心动过缓、低血压、血氧饱和度下降以及呼吸抑制的发生率更低。但在术后恶心、呕吐以及寒战的发生率方面两组差异无统计学意义。结论:在内镜下逆行胰胆管造影术中应用瑞马唑仑联合艾司氯胺酮,麻醉可控性好,对患者术中循环呼吸的影响小。鉴于本研究存在的局限性,仍需要更多高质量、大样本随机对照试验继续验证该联合用药在内镜下逆行胰胆管造影术中的效果。

Objective To systematically evaluate the effect of intravenous anesthesia with remimazolam and Esketamine in endoscopic retrograde cholangiopancreatography.Methods The databases of PubMed,Embase,Cochrane Library,Web of Science,Wanfang,CNKI and VIP were searched by computer.Randomized controlled trials(RCTs)of remimazolam combined with Esketamine in endoscopic retrograde cholangiopancreatography were systematically searched.The retrieval time was from the database establishment to October 2022.Revman 5.4 software was used for meta analysis.Results Totally 4 articles were included,including 350 patients.The results of this meta-analysis showed that compared with the control group,the heart rate,mean arterial pressure,blood oxygen saturation and respiratory rate of the intervention group after anesthesia were higher,and the incidence of bradycardia,hypotension,decreased blood oxygen saturation and respiratory depression during the operation was lower.However,there was no significant difference in the incidence of postoperative nausea,vomiting and chills between the two groups.Conclusion Remimazolam combined with Esketamine in endoscopic retrograde cholangiopancreatography has good anesthesia controllability and little influence on patients’circulation and respiration during operation.In view of the limitations of this study,more high-quality,large sample randomized controlled trials are still needed to continue to verify the effect of this combination of drugs in endoscopic retrograde cholangiopancreatography.