丙泊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meta分析  

The Comparison of Propofol and Inhalation Anesthesia on the Incidence of Early Postoperative Cognitive Dysfunction in the Elderly： a Meta-analysis

作　　者：许德奖[1,2] 杨威[1] 赵国栋[1] 

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

出　　处：《麻醉与监护论坛》2012年第5期364-367,共4页Forum of Anesthesia and Monitoring

基　　金：基金项目：广东省自然科学基金（10151008004000007）.广东省科技计划（20108031600153）

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2月．收集相关丙泊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stata12．0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0R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 propofol on the incidence of early postoperative cognitive dysfunction with inhalation anesthesia in the elderly undergoing noncardiac surgery. Methods： Up to February 2012, the randomized controlled trials （RCTs） that compared propofol on the incidence of early postoperative cognitive dysfunction with inhalation anesthesia in the elderly undergoing noncardiac surgery were searched from PubMed, Cochrane Library, CBM, CNKI, Wanfang data and VIP Database. The references were traced and further studied. After data extraction and quality evaluation, software stata 12.0 was used for statistical analysis. Results： 13 literatures including 2 literatures comparing propofol with xenon, 7 comparing propofol with sevoflurane, 4 comparing propofol with isoflurane were obtained, involving 753 patients. The results of meta-analysis showed that the odds ratio of the incidence of early postoperative cognitive dysfunction in the elderly between propofol anesthesia and xenon anesthesia, sevoflurane anesthesia, isoflurane anesthesia were 1.62 （0.81-3.23 with 95% confidence, p=0.533）, 0.67 （0.39-1.14 with 95% confidence, p=0.830）, 0.20 （0.08-0.50 with 95% confidence, p=0.925）, respectively. Overall, the odds ratio of the incidence of early postoperative cognitive dysfunction in the elderly between propofol anesthesia and inhalation anesthesia was 0.68（0.47-0.98 with 95%CI, p=0.189）. There was publication bias by Egger＇s test （p=0.011）. Conclusion： The incidence of early postoperative cognitive dysfunction of propofol anesthesia in the elderly was lower than inhalation anesthesia. However, limited to the low level of size and quality of the included studies, the conclusion requires well-designed, large scale, randomized controlled trials to strengthen.

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：R749.16[医药卫生—神经病学与精神病学]