改良电休克治疗中丙泊酚与依托咪酯对照研究的系统评价  

Propofol versus etomidate for modified electroconvulsive therapy:a systematic review of randomized clinical trials

作　　者：贾玉萍 苏亮[2] 梁世桥 徐一峰[1] 

机构地区：[1]上海交通大学医学院附属精神卫生中心,200030 [2]复旦大学附属华山医院精神科

出　　处：《临床麻醉学杂志》2014年第11期1059-1064,共6页Journal of Clinical Anesthesiology

基　　金：上海市级医院新兴前沿技术联合攻关项目(SHDC12012109);上海市卫生局项目(20134295)

摘　　要：目的丙泊酚和依托咪酯是改良电休克治疗中广泛使用的两种麻醉药物,但两者对电抽搐发作指标的影响和不良反应均不同,故进行两种药物系统评价。方法检索PubMed、Embase、WOK、中国期刊网、万方、维普及中国生物医学文献等数据库,截止时间为2013年10月8日。应用随机临床试验报道的声明(CONSORT)为参照标准进行入组和评价文献,采用RevMan和STATA软件进行Meta分析。结果共检索到19项患者研究符合纳入标准。丙泊酚组抽搐发作时间短于依托咪酯组(Z=6.83,SMD=-1.207,P<0.01)。两组抑制指数和苏醒时间差异无统计学意义。依托咪酯组躁动发生率明显高于丙泊酚组(Z=3.3,OR=0.135,P<0.01),两组头痛、注射痛、尿失禁差异均无统计学意义。结论改良电休克治疗中丙泊酚与依托咪酯比较,前者抽搐发作时间短,后者躁动发生率高,两者对抽搐指数影响差异无统计学意义。Objective Propofol and etomidate are widely used anesthetics in modified electroconvulsive therapy.However,there are differences in seizure effects and adverse reactions between the two medications.It is necessary to do a systematic review to compare the two drugs.Methods Standard search strategy for the cochrane review group was performed by two review authors.Searches were made in PubMed,Embase,and WOK,PsycINFO,Cochrane Library,CNKI,Wanfang,VIP and CBMDisc databases with the last search date on October 8,2013.Consolidated standards of reporting trials（CONSORT）statement were used to assess the methodological quality of the studies.RevMan and STATA were used to do Meta analysis.Results Nineteen studies met the inclusion criteria.Propofol group showed significant shorter duration than etomidate group（Z=6.83,SMD=-1.207,P〈0.01）in seizure length.There were no statistical differences in inhibition index and wake time between the two groups.Etomidate group showed higher agitation than propofol group（Z=3.3,OR=0.135,P〈0.01）.However,there were no significant differences in the incidence of headache,injection pain and urinary incontinence between the two groups.Conclusion These results suggest that propofol has shorter seizure time than etomidate,however,etomidate has much higher agitation in modified electroconvulsive therapy.There were no different effects on inhibition index between the two medications.

关 键 词：改良电休克 丙泊酚 依托咪酯 META分析 系统评价 

分 类 号：R614[医药卫生—麻醉学]