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目的系统评价七氟烷与氯胺酮比较用于小儿短小手术麻醉时的效果和安全性。方法采用Cochrane系统评价方法,检索EMbase、PubMed、Cochrane图书馆、CNKI、VIP、CBMdisc、Ongoing Controlled Trial、会议论文等数据库(检索时间均从建库至2011年4月),查找七氟烷用于小儿短小手术的随机对照试验(RCT)和半随机对照试验(quasi-RCT),对符合纳入标准的临床研究进行资料提取和质量评价后,采用RevMan 5.1.1软件进行Meta分析。结果共纳入10个研究,合计600例患者。7个研究结果显示,七氟烷组的术中心率低于氯胺酮组[MD=–11.85,95%CI(–16.47,–7.23),P<0.00001];9个研究结果显示,七氟烷组的术后苏醒时间短于氯胺酮组[MD=–29.05,95%CI(–37.98,–20.12),P<0.00001];3个研究结果显示,七氟烷组的手术麻醉诱导时间短于氯胺酮组[MD=–208.45,95%CI(–359.22,–57.68),P=0.007];6个研究结果显示,七氟烷组与氯胺酮组对平均动脉压的影响差异无统计学意义[MD=–4.86,95%CI(–10.02,0.29),P=0.06];7个研究结果显示,七氟烷组不良反应发生例数较氯胺酮组少[Peto OR=0.29,95%CI(0.20,0.40),P<0.00001]。结论本系统评价结果表明,七氟烷在效果方面优于氯胺酮,同时能有效减少不良反应,为当前小儿短小手术提供了一种新的麻醉药物,在临床上有较好的应用前景。但由于目前临床对本手术多采用氯胺酮等药物进行麻醉,因此,进行更高质量更有针对性的临床研究,提供七氟烷与各种传统麻醉方案相互对比的重要数据,是下一步需要深入研究的问题。
Objective To evaluate the efficacy and safety of sevoflurane and ketamine compared with short-term anesthesia in children. Methods The Cochrane systematic review method was used to search databases such as EMbase, PubMed, Cochrane Library, CNKI, VIP, CBMdisc, Ongoing Controlled Trial, meeting papers and so on (searching time from database to April 2011) In a randomized controlled trial (RCT) and quasi-RCT in pediatric short-term surgery, data from eligible clinical trials were extracted and evaluated for quality using the RevMan 5.1.1 software for meta-analysis. Results A total of 10 studies were included for a total of 600 patients. Seven studies showed that the sevoflurane group had lower intraoperative heart rate than ketamine group [MD = -11.85, 95% CI (-16.47, -7.23, P <0.00001]; nine studies showed that the sevoflurane group The recovery time was shorter in the sevoflurane group than in the ketamine group [MD = -29.05,95% CI (-37.98, -20.12), P <0.00001]. The results of the three studies showed that the anesthesia induction time in the sevoflurane group was shorter than that in the ketamine group (MD = -208.45,95% CI (-359.22, -57.68), P = 0.007]. Six studies showed no significant difference in mean arterial pressure between the sevoflurane group and the ketamine group [MD = - 4.86,95% CI (-10.02,0.29), P = 0.06]. Seven studies showed less adverse reactions in the sevoflurane group than those in the ketamine group [Peto OR = 0.29, 95% CI (0.20, 0.40) , P <0.00001]. Conclusion The results of this systematic review indicate that sevoflurane is superior to ketamine in efficacy and can effectively reduce adverse reactions. It provides a new narcotic drug for short pediatric surgery and has good clinical application. However, due to the clinical use of ketamine and other drugs for clinical anesthesia, higher-quality and more targeted clinical studies provide important data for the comparison between sevoflurane and traditional anesthesia programs. This is the next step that needs further study The problem.