成人腹股沟疝修补术中椎管内麻醉与全身麻醉的比较：系统评价和荟萃分析。
Comparison of spinal anesthesia and general anesthesia in inguinal hernia repair in adult: a systematic review and meta-analysis.
机构信息
Department of Thyroid, Breast, Hernia Surgery, Tianjin the third Central Hospital, NO.83, Jintang Road, Tianjin, 300170, China.
出版信息
BMC Anesthesiol. 2020 Mar 10;20(1):64. doi: 10.1186/s12871-020-00980-5.
BACKGROUND
Inguinal hernia repair is one of the most commonly performed surgical procedures. To date, there is no consensus on which anesthesia should be used. The objective of this meta-analysis was to assess the efficacy of spinal anesthesia (SA) vs. general anesthesia (GA) in inguinal hernia repair in adults.
METHODS
Eligible studies were identified before January 2020 from PubMed, Embase, ScienceDirect, Cochrane Library, Scopus database as well as reference lists. Outcomes included surgery time, the time in the operation room, the length of hospital stay, pain scores, patient satisfaction, and postoperative complications. Subgroup analysis based on surgical approaches was conducted.
RESULTS
Six randomized controlled trials (RCT) and five cohort studies were included. A total of 2593 patients were analyzed. Compared to GA, SA was associated with a longer surgery time (weighted mean difference [WMD]: - 3.28, 95%confident interval [CI]: - 5.76, - 0.81), particularly in laparoscopic repair. Postoperative pain at 4 h and 12 h were in favor of SA following either open or laparoscopic repairs (standard mean difference [SMD]: 1.58; 95%CI: 0.55, 2.61, SMD: 0.99, 95%CI: 0.37, 1.60, respectively); and considering borderline significance, patients receiving SA might be more satisfied with the anesthesia they used for herniorrhaphy (SMD: -0.32, 95%CI: - 0.70, 0.06). Some major complications of scrotal edema, seroma, wound infection, recurrence, shoulder pain were comparable between the two groups. However, patients receiving SA had an increased risk of postoperative urinary retention and headache when compared with GA (relative ratio [RR]: 0.44, 95% CI: 0.23, 0.86, RR: 0.33, 95% CI: 0.12, 0.92, respectively). There was a tendency that the incidence of postoperative nausea and vomiting was lower in SA than GA (RR: 2.12, 95%CI: 0.95, 4.73), especially in open herniorrhaphy.
CONCLUSIONS
SA can be another good choice for pain relief no matter in open or laparoscopic hernia repairs, but it can't be confirmed that SA is better than GA.
背景
腹股沟疝修补术是最常进行的手术之一。迄今为止，对于应该使用哪种麻醉方法尚无共识。本荟萃分析的目的是评估椎管内麻醉（SA）与全身麻醉（GA）在成人腹股沟疝修补术中的疗效。
方法
在 2020 年 1 月之前，从 PubMed、Embase、ScienceDirect、Cochrane 图书馆、Scopus 数据库以及参考文献列表中确定了符合条件的研究。结局包括手术时间、手术室时间、住院时间、疼痛评分、患者满意度和术后并发症。根据手术方式进行了亚组分析。
结果
共纳入了 6 项随机对照试验（RCT）和 5 项队列研究，共分析了 2593 例患者。与 GA 相比，SA 与手术时间较长相关（加权均数差 [WMD]：-3.28，95%置信区间 [CI]：-5.76，-0.81），尤其是在腹腔镜修补术中。无论开放或腹腔镜修补，术后 4 h 和 12 h 的疼痛均有利于 SA（标准均数差 [SMD]：1.58；95%CI：0.55，2.61，SMD：0.99，95%CI：0.37，1.60）；且考虑到边缘显著，接受 SA 的患者可能对疝修补术的麻醉更满意（SMD：-0.32，95%CI：-0.70，0.06）。阴囊水肿、血清肿、伤口感染、复发、肩部疼痛等主要并发症在两组间无差异。然而，与 GA 相比，接受 SA 的患者术后发生尿潴留和头痛的风险增加（相对风险 [RR]：0.44，95%CI：0.23，0.86，RR：0.33，95%CI：0.12，0.92）。SA 术后恶心和呕吐的发生率低于 GA（RR：2.12，95%CI：0.95，4.73），尤其是在开放疝修补术中，这一趋势更明显。
结论
无论在开放还是腹腔镜疝修补术中，SA 都可以作为一种缓解疼痛的良好选择，但尚不能确定 SA 优于 GA。
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