丙泊酚与气体麻醉对老年患者术后认知功能障碍的影响:Meta分析  

Effect of propofol and inhalation anesthesia on postoperative cognitive dysfunction in the elderly:a meta-analysis

作　　者：许德奖[1,2,3] 杨威[1,2] 赵国栋[1,2] 

机构地区：[1]广东省医学科学院 [2]广东省人民医院麻醉科,广东广州510080 [3]汕头大学医学院,广东汕头515041

出　　处：《南方医科大学学报》2012年第11期1623-1627,共5页Journal of Southern Medical University

基　　金：广东省自然科学基金(10151008004000007);广东省科技计划(2010B031600153)

摘　　要：目的比较丙泊酚与气体(氙气、七氟醚、异氟醚)全麻后老年患者术后早期认知功能障碍发生率的差异。方法系统检索Pubmed、Cochrane library、CBM、CNKI、万方、维普等数据库至2012年10月,收集相关丙白酚与气体麻醉后老年患者术后早期认知功能障碍发生率比较的文献,仔细阅读获取的文献摘要和全文后并对其参考文献进行追踪,对纳入文献进行数据提取并质量评价,采用Stata 12.0软件进行统计学分析。结果共纳入13篇文献,其中丙泊酚与氙气比较的文献2篇;丙泊酚与七氟醚比较的文献7篇;丙泊酚与异氟醚比较的文献4篇,共包括753例患者。Meta分析结果显示:丙泊酚麻醉对比氙气麻醉、七氟醚麻醉、异氟醚麻醉后老年患者术后早期认知功能障碍发生率的OR值分别为1.62(95%CI为0.81～3.23,P=0.533)、0.67(95%CI为0.39～1.14,P=0.830)、0.20(95%CI为0.08～0.50,P=0.925)。综合评价结果:丙泊酚麻醉对比气体麻醉后老年患者术后早期认知功能障碍发生率的OR值为0.68(95%CI为0.47～0.98,P=0.189)。Egger检验P=0.011显示有发表偏倚。结论丙泊酚麻醉比气体麻醉后老年患者术后早期认知功能障碍的发生率低,但囿于随机对照试验的数量及质量,上述结论仍需开展更大样本及严谨设计的随机对照试验加以论证。Objective To compare the effects of propofol and inhalation anesthesia on the incidence of early postoperative cognitive dysfunction （POCD） in elderly patients undergoing noncardiac surgeries. Methods PubMed, Cochrane Library, CBM, CNKI, Wanfang data and VIP Database （by October 2012） were searched for randomized controlled trials （RCTs） comparing propofol and inhalation anesthesia for their impact on the incidence of early POCD in elderly patients undergoing noncardiac surgeries. After data extraction and quaiity evaluation, Stata 12.0 software was used for statistical data analysis. Results Thirteen RCTs, including 2 comparing propofol with xenon, 7 comparing propofol with sevoflurane, and 4 comparing propofol with isoflurane were obtained, involving a total of 753 patients. The odds ratio of early POCD incidence between patients with propofol anesthesia and those with xenon anesthesia, sevoflurane anesthesia, and isoflurane anesthesia were 1.62 （95% CI 0.81-3.23, P=0.533）, 0.67 （95% CI 0.39-1.14, P=0.830）, and 0.20 （95% CI 0.08-0.50, P=0.925）, respectively. Overall, the odds ratio of early POCD incidence between propofol anesthesia and inhalation anesthesia was 0.68 （95% CI 0.47-0.98, P=0.189）. Egger＇s test showed a publication bias of the RCTs retrieved （P=0.011）. Conclusion Compared with inhalation anesthesia, propofol anesthesia is associated with a lower incidence of early POCD in elderly patients, but this conclusion needs to be further verified by more well-designed large-scale RCTs.

关 键 词：麻醉 丙泊酚 吸入麻醉 术后认知功能障碍 发生率 META分析 

分 类 号：R614[医药卫生—麻醉学]