丙泊酚与吸⼊麻醉药⽤于维持⽇间⼿术和住院⼿术患者全身麻醉的⽐ 较：系统回顾与meta分析
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Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and inpatient surgery: a systematic review and meta-analysis
背景与目的
丙泊酚⽤于麻醉维持是否优于吸⼊麻醉药⽬前尚不清楚。本研究旨在⽐较丙泊酚与吸⼊麻醉剂⽤于维持全身麻醉时对患者相关性结果和患者满意度的影响。
方 法
通过检索PubMed™、EMBASE™和Cochrane™数据库，收集1985年1⽉1⽇⾄2016年8⽉1⽇同⾏评审期刊中的随机对照试验（RCTs）。从6688项研究中，纳⼊了229例RCTs，共20991例患者。根据Cochrane标准进⾏质量控制，评估偏倚⻛险、meta偏倚、meta回归并确定资料可靠性，从存在异质性的固定或随机效应模型中导出⼀般估计。术后恶⼼呕吐（PONV）作为主要结果；术后疼痛、紧张焦虑、恢复时间、住院时间、麻醉后寒战和⾎流动⼒学不稳定性作为次要结果。
结 果
丙泊酚组的PONV⻛险低于吸⼊麻醉剂组（相关⻛险度（RR）0.61[0.53, 0.69],p < 0.00001）。此外，丙泊酚组拔管后疼痛评分和麻醉复苏室（PACU）内停留时间均减少（平均差异（MD） − 0.51 [− 0.81, −0.20], p = 0.001; MD − 2.91 min [− 5.47, − 0.35],p = 0.03）。相反地，丙泊酚组的呼吸恢复时间和⽓管导管拔除时间较吸⼊麻醉剂组⻓（MD0.82 min [0.20, 1.45], p = 0.01; MD 0.70 min [0.03, 1.38], p = 0.04）。值得注意的是，丙泊酚组的患者满意度（满意患者数量和评分）更⾼（RR1.06 [1.01, 1.10], p = 0.02; MD 0.13 [0.00, 0.26], p = 0.05）。次要结果分析与主要结果⼀致。
结 论
本项meta分析结果显示丙泊酚⽤于麻醉维持优于吸⼊麻醉药。虽然丙泊酚可提⾼患者满意度，但仍需进⾏充分有⼒的前瞻性临床试验以解决其临床应⽤和经济相关性等问题。
原始文献摘要
Schraag S,Pradelli L,Alsaleh AJO,et al.Propof ol vs. inhalational
agents to maintain general anaesthesia in ambulatory and
inpatient surgery: a systematic review and meta-analysis[J].BMC Anesthesiol, 2018 Nov 8;18(1):162-171. doi: 10.1186/s12871-018-0632-3.
Background: It is unclear if anaesthesia maintenance with propof ol is advantageous or beneficial over inhalational agents. This study is intended to compare the eff ects of propof ol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisf action.
Methods: Studies were identified by electronic database searches in PubMed , EMBASE and the Cochrane library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied. Of 6688 studies identified, 229 RCTs were included with a total of 20,991 patients. Quality control,assessment of risk of bias, meta-bias, meta-regression and certainty in evidence were perf ormed according to Cochrane.Common estimates were derived f rom fixed or random-eff ects models depending on the presence of
heterogeneity. Post-operative nausea and vomiting (PONV) was the primary outcome. Postoperative pain,emergence agitation, time to recovery, hospital length of stay, post-anaesthetic shivering and haemodynamicinstability were considered key secondary outcomes.
Results: The risk f or PONV was lower with propof ol than with inhalational agents (relative risk (RR) 0.61 [0.53, 0.69],p < 0.00001). Additionally, pain score af ter extubation and time in the postoperative anaesthesia care unit (PACU) were reduced with propof ol (mean diff erence (MD) 0.51 [ 0.81, 0.20], p = 0.001; MD 2.91 min [ 5.47, 0.35],p = 0.03). In turn, time to respiratory recovery and tracheal extubation were longer with propof ol than with inhalational agents (MD 0.82 min [0.20, 1.45], p = 0.01; MD 0.70 min [0.03, 1.38], p = 0.04, respectively). Notably,patient satisf action, as reported by the number of satisfied patients and scores, was higher with propof ol (RR 1.06 [1.01, 1.10], p = 0.02; MD 0.13 [0.00, 0.26], p = 0.05). Secondary analyses supported the primary results.
Conclusions: Based on the present meta-analysis there are several advantages of anaesthesia maintenance with propof ol over inhalational agents. While these benefits result in an increased patient satisf action, the clinical andeconomic relevance of these findings still need to be addressed in adequately powered prospective clinical trials.
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