椎管内麻醉与全身麻醉对关节置换术效果的Meta分析

Effects of neuraxial and general anaesthesia for total joint arthroplasty:a meta-analysis

中文关键词: 椎管内麻醉  全身麻醉  关节置换术  Meta分析；术后转归

英文关键词: Neuraxial anaesthesia  General anaesthesia  Joint arthroplasty  Meta-analysis

中文摘要:

      目的 通过Meta分析的方法评价椎管内麻醉与全身麻醉对关节置换术的效果。方法 计算机检索Pubmed、Web of Science、Cochrane Library、中国知网、中国生物医学数据库,检索中华系列杂志相关文献,收集所有评价椎管内麻醉与全身麻醉对关节置换术效果的随机对照试验（RCT）,筛选出符合的文献,并严格评价纳入研究的方法学质量。统计学软件采用Cochrane协作网提供的RevMan 5.3。结果 最终纳入21篇符合标准的RCT,共包含1 874例患者。Meta合并分析显示:与全身麻醉比较,椎管内麻醉可明显减少关节置换术术中出血量(WMD=-97.52 ml,95％CI=-173.60～-21.44,P=0.01),明显降低关节置换术深静脉血栓发生率(RR=0.68,95％CI=0.48～0.95,P=0.02)、肺栓塞发生率(RR=0.58,95％CI=0.35～0.91,P=0.03)、术后恶心呕吐发生率(RR=0.74,95％CI=0.60～0.92,P=0.008)。亚组分析显示,未使用抗凝药时椎管内麻醉可明显降低深静脉血栓发生率(RR=0.51,95％CI=0.38～0.69,P＜0.001)和肺栓塞发生率(RR=0.34,95％CI=0.18～0.65,P=0.001)。结论 椎管内麻醉在关节置换术中可有效改善患者术中情况,降低术后不良反应发生率。

英文摘要:

      Objective To evaluate the effect of neuraxial and general anaesthesia for total joint arthroplasty by meta-analysis. Methods We searched online Pubmed, Web of science,Cochrane library,CNKI,CBM and searched the literature of the Chinese series journals. All randomized controlled trials (RCT) that met their standards of neuraxial and general anaesthesia for total joint arthroplasty were collected. The quality of trials was strictly assessed. RevMan 5.3 software was used for data analysis. Results Twenty-one RCTs involving 1 874 cases were included. Compared with general anaesthesia,the pooled data showed that the neuraxial anaesthesia significantly reduced blood loss (WMD=-97.52,95％CI=-173.60--21.44,P=0.01),associated with lower risk of deep vein thrombosis (RR=0.68,95％CI=0.48-0.95,P=0.02) and pulmonary embolism (RR=0.58,95％CI=0.35-0.91,P=0.03), decreased the number of postoperative nausea and vomiting (RR=0.74,95％CI=0.60-0.92, P=0.008). Subgroup analysis showed that compared with general anaesthesia, the neuraxial anaesthesia associated with lower risk of deep vein thrombosis (RR=0.51,95％CI=0.38-0.69,P＜0.001) and pulmonary embolism (RR=0.34,95％CI=0.18-0.65,P=0.001) in patients who did not receive chemical antithrombotic prophylaxis. Conclusion Neuraxial anaesthesia seems to improve the outcome of patients undergoing total joint arthroplasty and reduce postoperative complications.