内镜逆行胰胆管造影术中镇静方式的选择：监护麻醉与全身麻醉一样安全吗？一项系统评价和荟萃分析。
Choice of sedation in endoscopic retrograde cholangiopancreatography: is monitored anesthesia care as safe as general anesthesia? A systematic review and meta-analysis.
作者信息
Dhaliwal Amaninder, Dhindsa Banreet Singh, Saghir Syed Mohsin, Ramai Daryl, Chandan Saurabh, Mashiana Harmeet, Bhogal Neil, Sayles Harlan, Bhat Ishfaq, Singh Shailender, Dam Aamir, Taunk Pushpak, Esquivel Rene Gomez, Klapman Jason, McDonough Stephanie, Adler Douglas G
机构信息
Division of Gastroenterology and Hepatology, Moffitt Cancer Center, Tampa, FL (Amaninder Dhaliwal, Aamir Dam, Jason Klapman).
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE (Banreet Singh Dhindsa).
出版信息
Ann Gastroenterol. 2021 Nov-Dec;34(6):879-887. doi: 10.20524/aog.2021.0650. Epub 2021 Jul 2.
BACKGROUND
Monitored anesthesia care (MAC) and general anesthesia (GA) are the 2 most common methods of sedation used for endoscopic retrograde cholangiopancreatography (ERCP). We performed a systematic review and meta-analysis to compare the overall safety between MAC vs. GA in ERCP.
METHODS
We conducted a comprehensive search of electronic databases to identify studies reporting the use of MAC or GA as a choice of sedation for ERCP. The primary outcome was to compare the overall rate of sedation-related adverse events in MAC vs. GA groups. The secondary endpoint was to investigate the total duration of the procedure, recovery time, ERCP cannulation rates, and conversion rate of MAC to GA. The meta-analysis was performed using a Der Simonian and Laird random-effects model.
RESULTS
A total of 21 studies reporting on 11,592 patients were included. The overall sedation-related side-effects were similar in the GA (12.76%, 95% confidence interval [CI] 5.80-21.73; I=95%) and MAC (12.08%, 95%CI 5.38-20.89; I=99%) groups (P=0.956). Hypoxia, arrhythmias, hypotension, aspiration and other sedation-related side-effects were similar between the 2 groups. The mean duration of the procedure was longer in the MAC group, but the mean recovery time was shorter. Significant heterogeneity was noted in our meta-analysis.
CONCLUSIONS
In our meta-analysis, the overall sedation-related side-effects were similar between the MAC and GA groups. MAC could be used as a safer alternative to GA when performing ERCP. However, large multicenter randomized control trials are needed to further validate our findings.
背景
监护麻醉（MAC）和全身麻醉（GA）是用于内镜逆行胰胆管造影（ERCP）的两种最常见的镇静方法。我们进行了一项系统评价和荟萃分析，以比较ERCP中MAC与GA的总体安全性。
方法
我们对电子数据库进行了全面检索，以识别报告将MAC或GA作为ERCP镇静选择的研究。主要结局是比较MAC组与GA组中镇静相关不良事件的总体发生率。次要终点是调查手术总时长、恢复时间、ERCP插管率以及MAC转为GA的转化率。使用Der Simonian和Laird随机效应模型进行荟萃分析。
结果
共纳入21项研究，涉及11,592例患者。GA组（12.76%，95%置信区间[CI] 5.80 - 21.73；I = 95%）和MAC组（12.08%，95%CI 5.38 - 20.89；I = 99%）的总体镇静相关副作用相似（P = 0.956）。两组之间的低氧血症、心律失常、低血压、误吸及其他镇静相关副作用相似。MAC组的平均手术时长较长，但平均恢复时间较短。我们的荟萃分析中观察到显著的异质性。
结论
在我们的荟萃分析中，MAC组和GA组的总体镇静相关副作用相似。在进行ERCP时，MAC可作为GA的一种更安全的替代方法。然而，需要大型多中心随机对照试验来进一步验证我们的发现。
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