术中七氟烷维持麻醉对单肺通气患者肺内分流率影响的meta分析

Meta-analysis on effect of sevoflurane-maintained anesthesia on intrapulmonary shunt fraction in patients during one-lung ventilation

目的系统评价术中七氟烷维持麻醉对单肺通气患者肺内分流率的影响。方法检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、中国知网全文数据库、万方数据库,收集七氟烷、丙泊酚、单肺通气相关的随机对照试验(RCTs),检索时间为建库至2022年3月。由2名独立的研究者根据纳入排除标准进行文献筛选,并提取肺内分流率、动脉血氧分压等数据。最后应用RevMan 5.3软件对纳入的RCTs进行meta分析。结果共纳入6个RCTs,包括244例患者,其中七氟烷组122例,丙泊酚组122例。meta分析结果提示,七氟烷组肺内分流率增加值高于丙泊酚组(MD=1.90,95%CI 0.61~3.19,P=0.004)。两组动脉血氧分压比较,差异无统计学意义(MD=2.23,95%CI-10.78~15.24,P=0.740)。结论对于行单肺通气患者,与丙泊酚相比,七氟烷维持麻醉可提高患者肺内分流率。

Objective To systematically evaluate the effect of sevoflurane-maintained anesthesia on intrapulmonary shunt fraction in patients during one-lung ventilation.Methods Randomized controlled trials(RCTs)related to sevoflurane,propofol,and one-lung ventilation were retrieved from PubMed,Embase,the Cochrane Library,CBM,CNKI,and Wanfang Database from their establishment to March 2022.Two independent researchers screened the literatures according to the inclusion and exclusion criteria and extracted the data of intrapulmonary shunt fraction and arterial partial pressure of oxygen(PaO2).The RevMan 5.3 software was used to conduct a meta-analysis on the included RCTs.Results Six RCTs with 244 patients were included,including 122 cases in the sevoflurane group and 122 cases in the propofol group.The results suggested that the intrapulmonary shunt fraction had a higher increase in the sevoflurane group than in the propofol group(MD=1.90,95%CI 0.61-3.19,P=0.004).There was no statistical difference in PaO2 between these two groups(MD=2.23,95%CI-10.78-15.24,P=0.740).Conclusion Compared with propofol,sevoflurane-maintained anesthesia for patients undergoing one-lung ventilation can increase their intrapulmonary shunt fraction.