Chen Lingyuan, Liang Xueyan, Tan Xinmei, Wen Haibin, Jiang Junsong, Li Yan
Department of Pharmacy.
Department of anesthesiology.
Medicine (Baltimore). 2019 May;98(20):e15712. doi: 10.1097/MD.0000000000015712.
Sedation with etomidate or propofol alone during gastroscopy has many side effects. A systematic review and meta-analysis were conducted to evaluate the safety and efficacy of the combined use of propofol and etomidate for sedation during gastroscopy.
PubMed, Embase, Medline (via Ovid SP), Cochrane library databases, CINAHL (via EBSCO), China Biology Medicine disc (CBMdisc), Wanfang, VIP, and China National Knowledge Infrastructure (CNKI) databases were systematically searched. We included randomized controlled trials (RCTs) comparing the combined use of propofol and etomidate vs etomidate or propofol alone for sedation during gastroscopy. Data were pooled using the random-effects models or fixed-effect model based on heterogeneity.
Fifteen studies with 2973 participants were included in the analysis. Compared to propofol alone, the combined use of propofol and etomidate possibly increased recovery time (SMD = 0.14, 95% CI = 0.04-0.24; P = .005), and the risk for myoclonus (OR = 3.07, 95% CI = 1.73-5.44; P < .001), injection pain, and nausea and vomiting. Furthermore, compared to propofol alone, the combination of propofol and etomidate produced an apparent beneficial effect for mean arterial pressure (MAP) after anesthesia (SMD = 1.32, 95% CI = 0.38-2.26; P = .006), SPO2 after anesthesia (SMD = 0.99, 95% CI = 0.43-1.55; P < .001), apnea or hypoxemia (OR = 0.16, 95% CI = 0.08-0.33; P < .001), injection pain, and body movement. Further, compared to etomidate alone, the combination of propofol and etomidate reduced the risk for myoclonus (OR = 0.15, 95% CI = 0.11-0.22; P < .001), body movement, and nausea and vomiting.
The combination of propofol and etomidate might increase recovery time vs that associated with propofol, but it had fewer side effects on circulation and respiration in patients undergoing gastroscopy. The combined use of propofol and etomidate can improve and produce an apparent beneficial effect on the adverse effects of propofol or etomidate alone, and it was safer and more effective than propofol or etomidate alone.
在胃镜检查期间单独使用依托咪酯或丙泊酚进行镇静有许多副作用。进行了一项系统评价和荟萃分析，以评估丙泊酚与依托咪酯联合用于胃镜检查镇静的安全性和有效性。
系统检索了PubMed、Embase、Medline（通过Ovid SP）、Cochrane图书馆数据库、CINAHL（通过EBSCO）、中国生物医学光盘数据库（CBMdisc）、万方、维普和中国知网数据库。我们纳入了比较丙泊酚与依托咪酯联合使用与单独使用依托咪酯或丙泊酚用于胃镜检查镇静的随机对照试验（RCT）。根据异质性，使用随机效应模型或固定效应模型汇总数据。
分析纳入了15项研究，共2973名参与者。与单独使用丙泊酚相比，丙泊酚与依托咪酯联合使用可能会增加恢复时间（标准化均数差[SMD]=0.14，95%置信区间[CI]=0.04-0.24；P=0.005）、肌阵挛风险（比值比[OR]=3.07，95%CI=1.73-5.44；P<0.001）、注射痛以及恶心和呕吐。此外，与单独使用丙泊酚相比，丙泊酚与依托咪酯联合使用对麻醉后平均动脉压（MAP）产生明显有益影响（SMD=1.32，95%CI=0.38-2.26；P=0.006）、麻醉后血氧饱和度（SPO2）（SMD=0.99，95%CI=0.43-1.55；P<0.001）、呼吸暂停或低氧血症（OR=0.16，95%CI=0.08-0.33；P<0.001）、注射痛和身体移动。此外，与单独使用依托咪酯相比，丙泊酚与依托咪酯联合使用降低了肌阵挛风险（OR=0.15，95%CI=0.11-0.22；P<0.001）、身体移动以及恶心和呕吐。
与丙泊酚相比，丙泊酚与依托咪酯联合使用可能会增加恢复时间，但对接受胃镜检查的患者的循环和呼吸副作用较少。丙泊酚与依托咪酯联合使用可改善并对单独使用丙泊酚或依托咪酯的不良反应产生明显有益影响，且比单独使用丙泊酚或依托咪酯更安全、更有效。
