【罂粟摘要】术中麻醉交接与患者发病率和死亡率的关系：一项系统回顾和Meta分析
术中麻醉交接与患者发病率和死亡率的关系：一项系统回顾和Meta分析
翻译：吴学艳 编辑：佟睿 审校：曹莹
贵州医科大学高鸿教授课题组
背景：手术中麻醉病人护理的移交是很常见，然而，它与病人预后的关系尚不清楚；此项系统回顾旨在评估手术中麻醉交接对患者预后的影响。
方法：在从成立至2019年4月24日在Medline、Medline in Process、CINAHL和Embase中进行检索，纳入的研究参考文献列表包括所有前瞻性和回顾性的临床研究，特别是调查术中麻醉护理在麻醉医生之间的交接与患者发病率和死亡率的关系。数据由独立审查员提取，一式两份；若有分歧通过协商一致解决或第三名评审员解决，对研究资格进行评估；使用美国国立卫生研究院质量评估工具对观察队列和横断面研究进行一式两份偏倚风险评估，对数据进行叙述性总结，并给出实质性的异质性；对可比性研究采用随机效应模型进行探索性Meta分析。
结果：8项研究符合纳入标准,6项研究以患者为分析单位(n=605678)，2项研究以麻醉提供者为分析单位(n=307);七项研究确定了麻醉交接与患者不良预后之间的关系，而另一项研究则表明，交接可能有利于发现或纠正错误；纳入的研究质量一般或良好。四项研究的Meta分析发现，在手术过程中发生麻醉交接时，患者发生不良事件的风险增加40%(合并风险比=1.4；95%CI，1.19%-1.65%；P<0.001；I2=98%)。
结论：术中麻醉交接通常会增加手术患者的发病率和死亡率，但在某些情况下可能会提高患者安全性；未来的研究应明确影响安全性的具体交接特征。
原始文献来源：Boet S, Djokhdem H, Leir SA, et al.Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis.Br J Anaesth 2020 10;1254(4).
Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis
Background: Handover of anaesthesia patient care during surgery is common; however, its association with patient outcome is unclear.This systematic review aimed to assess the impact of anaesthesia handover during surgery on patient outcome.
Methods: All prospective and retrospective clinical studies specifically investigating the association of intraoperative transfer of anaesthesia care between anaesthesia Providers in the operating room with patient morbidity and mortality were included. Searches were conducted from inception to April 24, 2019 in Medline, Medline in Process, CINAHL, and Embase. Reference lists of included studies were searched. Studies were assessed for eligibility and data were extracted by independent reviewers in duplicate with disagreements resolved by consensus or a third reviewer.Risk of bias was assessed in duplicate using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were summarised narratively given substantial heterogeneity. An exploratory meta-analysis was conducted using a random-effects model for a subset of comparable studies.
Results: Eight studies met the inclusion criteria. Six studies focused on patients as the unit of analysis (n=605 678) and two focused on anaesthesia providers as the unit of analysis (n=307).Seven studies identified a relationship between anaesthesia handovers and adverse patient outcomes, whereas one suggested that handover may be beneficial to error detection or rectification. Included studies were of fair or good quality. Meta-analysis of four studies found a 40% increased risk of patients experiencing an adverse event when an anaesthesia handover occurs during the procedure (pooled risk ratio=1.40; 95% confidence interval, 1.19 to 1.65; P<0.001; I=98%).
Conclusions: Intraoperative anaesthesia handovers generally increase morbidity and mortality for surgical patients but could have the potential to improve safety in certain contexts. Future research should determine the specific handover characteristics that impact safety.