Yao Yun-Tai, Li Li-Huan
Department of Anesthesiology, Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
Chin Med Sci J. 2009 Sep;24(3):133-41. doi: 10.1016/s1001-9294(09)60077-8.
To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting (CABG) surgery.
Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients' perioperative data, including patients' baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio (OR) and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity (Q test P<0.05). Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P<0.05.
Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups (all P>0.05). Patients randomized into sevoflurane group had higher post-bypass cardiac index (WMD=0.39, 95% CI: 0.18 to 0.60, P=0.0003), lower troponin I level (WMD=-0.82, 95% CI: -0.87 to -0.85, P=0.0002), lower incidence of myocardial ischemia (OR=0.37, 95% CI: 0.16 to 0.83, P=0.02), shorter ICU and hospital stay length (WMD=-10.99, 95% CI: -12.97 to -9.01, P<0.00001; WMD=-0.78, 95% CI: -1.00 to -0.56, P<0.00001, respectively).
This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.
系统评价随机对照试验，比较七氟醚与丙泊酚在冠状动脉旁路移植术（CABG）患者中的心肌保护情况。
检索电子数据库，以识别所有比较七氟醚与丙泊酚对接受CABG手术成年患者心肌保护作用的随机对照试验。两名作者独立提取患者围手术期数据，包括患者基线特征、手术变量和结局数据。对于连续变量，治疗效果计算为加权平均差（WMD）和95%置信区间（CI）。对于二分数据，治疗效果计算为比值比（OR）和95%CI。对每个结局进行异质性检验，存在或不存在显著异质性（Q检验P<0.05）时分别使用随机效应或固定效应模型。通过检查统计模型对估计治疗效果的影响进行敏感性分析。通过直观检查结局的漏斗图探索发表偏倚。统计学显著性定义为P<0.05。
我们的检索产生了13项研究，包括696例患者，402例患者被分配到七氟醚组，294例被分配到丙泊酚组。两组之间术后机械通气时间、血管活性药物支持、死亡率、心肌梗死和房颤无显著差异（均P>0.05）。随机分配到七氟醚组的患者术后心脏指数较高（WMD=0.39，95%CI：0.18至0.60，P=0.0003），肌钙蛋白I水平较低（WMD=-0.82，95%CI：-0.87至-0.85，P=0.0002），心肌缺血发生率较低（OR=0.37，95%CI：0.16至0.83，P=0.02），重症监护病房（ICU）和住院时间较短（WMD=-10.99，95%CI：-12.97至-9.01，P<0.00001；WMD=-0.78，95%CI：-1.00至-0.56，P<0.00001）。
这项荟萃分析发现一些证据表明，在CABG手术中七氟醚比丙泊酚具有更好的心肌保护作用。
