围手术期输注氨基酸可预防低温和提高全麻手术患者的临床疗效：系统评价和 Meta分析
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Perioperative Amino Acid Infusion for Preventing Hypothermia and Improving Clinical Outcomes During Surgery Under General Anesthesia: A Systematic Review and Meta-analysis
背景与目的
全身麻醉有时会选择输注氨基酸来避免体温过低，但目前输注氨基酸尚未建立广泛的临床应用。本研究的目的是明确输注氨基酸是否可以提高患者的体温和改善临床结局。
方 法
我们搜索了2015年11月MEDLINE（PubMed），Cochrane 和Igaku Chuo Zasshi 数据库，由2名评估员分别对全麻手术以及全麻手术复合硬膜外麻醉下手术涉及输注氨基酸的随机对照试验（RCT）。主要结局是围手术期输注氨基酸前后体温差异。次要结局为寒颤发生率，失血量，插管时间、住院时间。
结 果
共纳入14个RCT，共626例（输注氨基酸组327例，对照组299例），626例来自14个RCT，结果显示输注氨基酸可增加体温，平均差（MD）为0.46℃（95％置信区间[CI]，0.31-0.62，低质量证据），输注氨基酸可降低寒颤的发生率，风险比为0.34（95％CI，0.12-0.94; 7 个RCT，248例，非常低的质量证据），可缩短插管时间（95％CI，-10〜-8.8; 2个RCT，158例，中等质量证据），与对照组相比，住院时间缩短（95％CI，-.07〜-5.5; 3个RCT，230例，低质量证据），失血量组间差异无统计学意义（标准化MD，-20,205％CI，-44〜0.04;低质量证据）。
结 论
与对照组相比，围手术期输注氨基酸可增加患者体温，改善临床结局。 然而，输注氨基酸的证据支撑是有限的，需要进一步大规模的RCT。
原始文献摘要
Aoki Y,Aoshima Y，Atsumi K,et al.Perioperative Amino Acid Infusion for Preventing Hypothermia and Improving Clinical Outcomes During Surgery Under General Anesthesia: A Systematic Review and Meta-analysis Anesth Analg. Jul 24，2017. doi: 10.1213/ANE.0000000000002278
BACKGROUND: Amino acid (AA) infusion is sometimes selected to avoid hypothermia during general anesthesia.However,the widespread clinical use of AA infusion therapy has not been established.This study aimed to clarify the evidence that AA infusion can increase patient body temperature and improve clinical outcomes using the Grading of Recommendations Assessment,Development,and Evaluation system.
METHODS: We searched MEDLINE (PubMed),Cochrane Central Register of Controlled Trials,and Igaku Chuo Zasshi (Japana Centra Revuo Medicina) in November 2015.Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs)involving AA infusion compared with placebos during surgery under general or combined general/epidural anesthesia.Study quality was assessed using the Grading of Recommendations Assessment,Development,and Evaluation system and the Cochrane methodology.The primary outcome was difference in body temperature before and after perioperative AA infusion.Shivering frequency,blood loss volume,postoperative intubation time,and hospitalization period were also From 298 screened titles。
RESULTS: 14 RCTs met our inclusion criteria, including 626 patients (327 in AA and 299 in placebo groups).In 626 participants from 14 RCTs,AA infusion increased body temperature by a mean difference (MD) of 0.46°C(95% confidence interval[CI],0.310.62,low-quality evidence). Regarding other outcomes, AA infusion decreased shivering frequency by a risk ratio of 0.34 (95% CI, 0.12–0.94;7 RCTs, 248 participants, very low-quality evidence),shortened postoperative intubation time by MD of -25 minutes (95% CI,-10 to-8.8; 2 RCTs,158 participants,moderate-quality evidence), and shortened the hospitalization period by MD of -.81 days (95% CI,-.07 to -.55;3 RCTs, 230 participants, low-quality evidence) compared with placebo.There was no significant difference in the volume of blood loss between the 2 groups (standardized MD,-.20, 95% CI,-.44 to 0.04; low-quality evidence).There was no publication bias.
CONCLUSIONS: AA infusion in the perioperative period increased patient body temperature and improved clinical outcomes compared with placebo. However,the evidence to support the use of AA infusion is limited,and further large-scale RCTs are required.
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