丙泊酚对肝细胞癌麻醉手术期间肝脏缺血再灌注损伤保护作用的荟萃分析与系统评价

A meta-analysis and systematic review of propofol on liver ischemia-reperfusion injury protection during hepatocellular carcinoma anesthesia surgery.

作者信息

Feng Changsheng, Qian Duo, Chen Changlin

机构信息

Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.

出版信息

Ann Palliat Med. 2021 Jun;10(6):6726-6735. doi: 10.21037/apm-21-1242. Epub 2021 Jun 16.

DOI:10.21037/apm-21-1242

PMID:34154355

Abstract

BACKGROUND

At present, liver cancer deaths of China account for about half of the global liver cancer deaths. The most common physiological change in anesthesia surgery for liver cancer is liver ischemia-reperfusion injury (LIRI).

METHODS

The Chinese and English medical databases were searched using a combination of the following search terms: "propofol", "liver cancer", "anesthesia surgery", and "ischemia reperfusion injury" in Chinese or English language, respectively. The articles taking patients received propofol intravenous anesthesia surgery for LIRI in the experimental group and patients received intravenous anesthesia with non-propofol drugs for LIRI in the control group were searched. Rev Man 5.3 software was used for meta-analysis.

RESULTS

A total of 18 articles were included, and most were considered to have low-risk bias (that is, medium- and high-quality publications). The meta-analysis results indicated that the superoxide dismutase (SOD) levels from the blockage of the hepatic hilum (B-HH) to the 15-minute opening of the hepatic hilum (O-HH) showed a mean deviation (MD) of -0.33 nU/mL and 95% confidential interval (CI) of -1.81 to 1.15 nmol/L (P<0.05). The levels of malondialdehyde (MDA) from B-HH to O-HH showed a MD of 1.80 nmol/L and 95% CI of 1.53 to 2.07 nmol/l (P<0.05). The MD of alanine transaminase (ALT) levels from B-HH to O-HH was 8.24 IU/L with 95% CI 6.43 to 10.06 IU/L (P<0.05). The MD of aspartate transaminase (AST) levels from B-HH to O-HH was -11.73 IU/L with 95% CI -14.04 to -9.43 IU/L (P<0.05). The RevMan5.3 software was used to draw the funnel chart for each indicator from B-HH to OHH. The results revealed that the circles in some articles were concentrated on the midline and were basically symmetrical with the midline, indicating that the research accuracy was high and there was no bias in publication.

DISCUSSION

This meta-analysis confirmed that propofol exerted a protective effect on LIRI during anesthesia surgery with hepatic hilar blockade.

摘要

背景

目前，中国肝癌死亡人数约占全球肝癌死亡人数的一半。肝癌麻醉手术中最常见的生理变化是肝缺血再灌注损伤（LIRI）。

方法

分别使用以下搜索词的组合在中国和英文医学数据库中进行搜索：中文或英文的“丙泊酚”“肝癌”“麻醉手术”和“缺血再灌注损伤”。检索实验组接受丙泊酚静脉麻醉手术治疗LIRI的文章以及对照组接受非丙泊酚药物静脉麻醉治疗LIRI的文章。使用Rev Man 5.3软件进行荟萃分析。

结果

共纳入18篇文章，大多数被认为具有低风险偏倚（即中高质量出版物）。荟萃分析结果表明，从肝门阻断（B-HH）至肝门开放15分钟（O-HH）时超氧化物歧化酶（SOD）水平的平均偏差（MD）为-0.33 nU/mL，95%置信区间（CI）为-1.81至1.15 nmol/L（P<0.05）。从B-HH至O-HH时丙二醛（MDA）水平的MD为1.80 nmol/L，95%CI为1.53至2.07 nmol/l（P<0.05）。从B-HH至O-HH时丙氨酸转氨酶（ALT）水平的MD为8.24 IU/L，95%CI为6.43至10.06 IU/L（P<0.05）。从B-HH至O-HH时天冬氨酸转氨酶（AST）水平的MD为-11.73 IU/L，95%CI为-14.04至-9.43 IU/L（P<0.05）。使用RevMan5.3软件绘制从B-HH至OHH各指标的漏斗图。结果显示，部分文章中的圆圈集中在中线上，且与中线基本对称，表明研究准确性高，不存在发表偏倚。