内镜逆行胰胆管造影术麻醉和镇静方案的比较疗效与安全性：一项网状Meta分析
Comparative Efficacy and Safety of Anesthetic and Sedative Regimens for Endoscopic Retrograde Cholangiopancreatography: A Network Meta-Analysis.
作者信息
Liu Yufang, Xiao Jifeng, Chen Tian, Shi Dongdong, Qiao Yan, Liao Xingzhi
机构信息
Department of Anesthesiology, 904th Hospital of The Joint Logistics Support Force of the PLA, Wuxi, China.
出版信息
Dig Dis. 2025;43(1):84-95. doi: 10.1159/000542380. Epub 2024 Nov 13.
INTRODUCTION
This study evaluates the efficacy and safety of various anesthetic and sedative regimens for endoscopic retrograde cholangiopancreatography (ERCP) procedures.
METHODS
A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios.
RESULTS
42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR <0.01), dexmedetomidine plus fentanyl (RR <0.01), propofol plus nalbuphine (RR = 0.01), Mg sulfate plus propofol (RR = 0.01), and propofol plus fentanyl (RR = 0.02) showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR = 0.01), propofol plus oxycodone (RR = 0.09), and dexmedetomidine plus fentanyl (RR = 0.2) exhibited lower rates of adverse events compared to propofol.
CONCLUSION
This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.
INTRODUCTION
This study evaluates the efficacy and safety of various anesthetic and sedative regimens for endoscopic retrograde cholangiopancreatography (ERCP) procedures.
METHODS
A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios.
RESULTS
42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR <0.01), dexmedetomidine plus fentanyl (RR <0.01), propofol plus nalbuphine (RR = 0.01), Mg sulfate plus propofol (RR = 0.01), and propofol plus fentanyl (RR = 0.02) showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR = 0.01), propofol plus oxycodone (RR = 0.09), and dexmedetomidine plus fentanyl (RR = 0.2) exhibited lower rates of adverse events compared to propofol.
CONCLUSION
This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.
引言
本研究评估了用于内镜逆行胰胆管造影（ERCP）手术的各种麻醉和镇静方案的疗效和安全性。
方法
在PubMed、科学网、Scopus和Embase上进行了系统检索，以识别截至2024年3月发表的随机对照试验（RCT）。主要结局包括手术时间、患者满意度、血氧饱和度（SpO2）、SpO2低于90%的发生率以及不良事件。使用R软件进行分析，采用均值差分析连续结局，采用风险比分析二分结局。
结果
纳入了42项RCT。瑞芬太尼联合曲马多以及丙泊酚联合咪达唑仑联合哌替啶等联合治疗方案的手术时间显著缩短。丙泊酚联合羟考酮使患者满意度更高。氧合结果表明，丙泊酚联合芬太尼、羟考酮和氯胺酮可改善SpO2。与丙泊酚相比，丙泊酚联合羟考酮（RR<0.01）、右美托咪定联合芬太尼（RR<0.01）、丙泊酚联合纳布啡（RR=0.01）、硫酸镁联合丙泊酚（RR=0.01）以及丙泊酚联合芬太尼（RR=0.02）的SpO2低于90%的患者比例显著更低。与丙泊酚相比，咪达唑仑联合哌替啶联合右美托咪定（RR=0.01）、丙泊酚联合羟考酮（RR=0.09）以及右美托咪定联合芬太尼（RR=0.2）的不良事件发生率更低。
结论
本研究提供了全面的证据，以指导临床决策并优化ERCP手术的麻醉管理。
引言
本研究评估了用于内镜逆行胰胆管造影（ERCP）手术的各种麻醉和镇静方案的疗效和安全性。
方法
在PubMed、科学网、Scopus和Embase上进行了系统检索，以识别截至2024年3月发表的随机对照试验（RCT）。主要结局包括手术时间、患者满意度、血氧饱和度（SpO2）、SpO2低于90%的发生率以及不良事件。使用R软件进行分析，采用均值差分析连续结局，采用风险比分析二分结局。
结果
纳入了42项RCT。瑞芬太尼联合曲马多以及丙泊酚联合咪达唑仑联合哌替啶等联合治疗方案的手术时间显著缩短。丙泊酚联合羟考酮使患者满意度更高。氧合结果表明，丙泊酚联合芬太尼、羟考酮和氯胺酮可改善SpO2。与丙泊酚相比，丙泊酚联合羟考酮（RR<0.01）、右美托咪定联合芬太尼（RR<0.01）、丙泊酚联合纳布啡（RR=0.01）、硫酸镁联合丙泊酚（RR=0.01）以及丙泊酚联合芬太尼（RR=0.02）的SpO2低于90%的患者比例显著更低。与丙泊酚相比，咪达唑仑联合哌替啶联合右美托咪定（RR=0.01）、丙泊酚联合羟考酮（RR=0.09）以及右美托咪定联合芬太尼（RR=0.2）的不良事件发生率更低。
结论
本研究提供了全面的证据，以指导临床决策并优化ERCP手术的麻醉管理。
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