挥发性麻醉剂与异丙酚在体外循环心脏手术中的比较：随机试验的荟萃分析。
Volatile Anesthetics versus Propofol for Cardiac Surgery with Cardiopulmonary Bypass: Meta-analysis of Randomized Trials.
机构信息
From the Departments of Cardionephrology, (A.B., l.M., G.D.) Intensive Care Unit (M.A.G.) Cardiac Surgery (L.M.), Clinical Ligurian Institute of High Specialty, Villa Maria Group (GVM) Care and Research, Rapallo, Italy the Division of Internal Medicine, International Evangelical Hospital, Genoa, Italy (A.B.) the Departments of Health Science (A.S.) of Internal Medicine (G.D.), University of Genoa, Italy the ASL-2-Regional Health System of Liguria, Italy (C.A.).
出版信息
Anesthesiology. 2020 Jun;132(6):1429-1446. doi: 10.1097/ALN.0000000000003236.
BACKGROUND
The aim of this systematic review and meta-analysis was to assess the effect of anesthesia maintenance with volatile agents compared with propofol on both short- and long-term mortality (primary outcomes) and major clinical events in adults undergoing cardiac surgery with cardiopulmonary bypass.
METHODS
Randomized clinical trials on the effects of current volatile anesthetics versus propofol in adults undergoing cardiac surgery with cardiopulmonary bypass were searched (1965 to September 30, 2019) in PubMed, the Cochrane Library, and article reference lists. A random effect model on standardized mean difference for continuous outcomes and odds ratio for dichotomous outcomes were used to meta-analyze data.
RESULTS
In total, 37 full-text articles (42 studies, 8,197 participants) were included. The class of volatile anesthetics compared with propofol was associated with lower 1-yr mortality (5.5 vs. 6.8%; odds ratio, 0.76 [95% CI, 0.60 to 0.96]; P = 0.023), myocardial infarction (odds ratio, 0.60 [95% CI, 0.39 to 0.92]; P = 0.023), cardiac troponin release (standardized mean difference, -0.39 [95% CI, -0.59 to -0.18], P = 0.0002), need for inotropic medications (odds ratio, 0.40 [95% CI, 0.24 to 0.67]; P = 0.0004), extubation time (standardized mean difference, -0.35 [95% CI, -0.68 to -0.02]; P = 0.038), and with higher cardiac index/output (standardized mean difference, 0.70 [95% CI, 0.37 to 1.04]; P < 0.0001). The class of volatile anesthetics was not associated with changes in short-term mortality (1.63 vs. 1.65%; odds ratio, 1.04 [95% CI, 0.73 to 1.49]; P = 0.820) and acute kidney injury (odds ratio, 1.25 [95% CI, 0.77 to 2.03]; P = 0.358).
CONCLUSIONS
In adults undergoing cardiac surgery with cardiopulmonary bypass, the class of volatile anesthetics was superior to propofol with regard to long-term mortality, as well as to many secondary outcomes indicating myocardial protection.
背景
本系统评价和荟萃分析的目的是评估与丙泊酚相比，挥发性麻醉剂维持麻醉对体外循环心脏手术成人的短期和长期死亡率（主要结局）和主要临床事件的影响。
方法
检索了 1965 年至 2019 年 9 月 30 日期间在 PubMed、Cochrane 图书馆和文章参考文献列表中有关当前挥发性麻醉剂与丙泊酚对体外循环心脏手术成人影响的随机临床试验。使用标准化均数差值对连续结局和二项结局比值比进行荟萃分析。
结果
共纳入 37 篇全文文章（42 项研究，8197 名参与者）。与丙泊酚相比，挥发性麻醉剂组 1 年死亡率较低（5.5%比 6.8%；比值比，0.76 [95%置信区间，0.60 至 0.96]；P = 0.023），心肌梗死（比值比，0.60 [95%置信区间，0.39 至 0.92]；P = 0.023），心肌肌钙蛋白释放（标准化均数差值，-0.39 [95%置信区间，-0.59 至 -0.18]，P = 0.0002），需要使用正性肌力药物（比值比，0.40 [95%置信区间，0.24 至 0.67]；P = 0.0004），拔管时间（标准化均数差值，-0.35 [95%置信区间，-0.68 至 -0.02]；P = 0.038），以及更高的心输出量/指数（标准化均数差值，0.70 [95%置信区间，0.37 至 1.04]；P < 0.0001）。挥发性麻醉剂组与短期死亡率（1.63%比 1.65%；比值比，1.04 [95%置信区间，0.73 至 1.49]；P = 0.820）和急性肾损伤（比值比，1.25 [95%置信区间，0.77 至 2.03]；P = 0.358）无变化相关。
结论
在体外循环心脏手术成人中，与丙泊酚相比，挥发性麻醉剂类药物在长期死亡率以及许多表明心肌保护的次要结局方面更具优势。
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