针刺复合麻醉应用于传统甲状腺切除术的系统评价与Meta分析

Acupuncture compound anesthesia for traditional thyroidectomy:a systematic review and meta-analysis

目的:评估针刺复合麻醉(ACA)应用于传统甲状腺切除术的疗效和安全性。方法:检索PubMed、EMBASE、Cochrane图书馆、科学网、中国知网(CNKI)、重庆维普数据库(CQVIP)、万方数据库(Wanfang)及中国生物医学文献数据库(CBM),收集自建库至2021年9月30日期间ACA应用于传统甲状腺切除术的随机对照试验。两位研究者各自独立进行数据提取、偏倚风险评估及文献质量评价。本文采用麻醉效果作为主要结局指标,次要结局指标包括各疼痛量表评分、生命体征、麻醉药物用量以及不良反应。采用Review Manager 5.3软件进行Meta分析。使用加权均数差(WMD)、标准化均数差(SMD)和可信区间(CI)进行统计描述。结果:共纳入16篇研究,计1228位患者。Meta分析显示,传统甲状腺切除术中联合针刺能够显著提高麻醉效果[SMD=0.62,95%CI(0.40,0.83),P<0.0001,I^(2)=36%];此外,ACA也能稳定生命体征,减轻疼痛[SMD=-1.61,95%CI(-2.61,-0.61),P<0.00001,I^(2)=95%]、减少麻醉药物用量及不良反应。针对电针组的亚组分析显示,低频电刺激[WMD=0.43,95%CI(0.30,0.55),P<0.00001,I^(2)=15%]和术中全程接受电刺激[WMD=0.55,95%CI(0.33,0.77),P<0.00001,I^(2)=0%]的麻醉效果明显优于高频电刺激或术中短时间接受电刺激。此外,传统麻醉方法与单纯针刺麻醉之间未发现统计学差异。结论:针刺联合传统麻醉时,ACA应用于传统甲状腺切除术疗效及安全性较好。然而,该结论仍需要更多高质量、大样本的研究加以验证。

Objective:To assess the efficacy and safety of acupuncture compound anesthesia(ACA)for traditional thyroidectomy.Methods:Randomized controlled trials(RCTs)studying the use of ACA for traditional thyroidectomy were retrieved from PubMed,Excerpta Medica Database(EMBASE),Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),Chongqing VIP Database(CQVIP),Wanfang Academic Journal Full-text Database(Wanfang),and China Biology Medicine Disc(CBM)from inception to September 30,2021.Two investigators independently extracted data and assessed the risk of bias and quality of the studies.Anesthesia effectiveness was the primary outcome,while the secondary outcomes included various pain scales,vital signs,analgesic consumption,and adverse events.Review Manager 5.3 was used for meta-analysis.Weighted mean difference(WMD),standardized mean difference(SMD),and confidence interval(CI)were used for statistical descriptions.Results:A total of 16 papers were included,involving 1228 patients.Meta-analysis showed that anesthesia effectiveness was significantly improved after adding acupuncture as an adjunct[SMD=0.62,95%CI(0.40,0.83),P<0.0001,I^(2)=36%].Besides,ACA can also moderate vital signs and reduce the feeling of pain[SMD=-1.61,95%CI(-2.61,-0.61),P<0.00001,I^(2)=95%],analgesic consumption,and adverse events.Subgroup analysis of the electroacupuncture(EA)group further revealed that the effectiveness of low-frequency EA[WMD=0.43,95%CI(0.30,0.55),P<0.00001,I^(2)=15%]and the entire operative stimulation of EA[WMD=0.55,95%CI(0.33,0.77),P<0.00001,I^(2)=0%]was significantly better than high-frequency EA and short-time stimulation of EA during the operation.Further,no significant difference existed between conventional analgesia and acupuncture analgesia.Conclusion:ACA is beneficial to traditional thyroidectomy regarding efficacy and safety when acupuncture is applied as an adjunct.However,additional high-quality studies with larger sample sizes are needed to verify the findings.