椎管内阻滞对心脏事件高危患者行非心脏手术后心肌梗死影响的Meta分析  

Effect of intrathecal blockade on postoperative myocardial infarction in noncardiac surgical patients:a meta-analysis

作　　者：安然[1] 刘红亮[1] 庞倩芸[1] 陈博[1] 

机构地区：[1]重庆市肿瘤研究所手术麻醉科,400030

出　　处：《临床麻醉学杂志》2017年第8期780-784,共5页Journal of Clinical Anesthesiology

摘　　要：目的采用Meta分析比较椎管内阻滞[包括硬膜外阻滞(epidural anesthesia,EA)和蛛网膜下腔阻滞(spinal anesthesia,SA)]复合全身麻醉(general anesthesia,GA)对非心脏手术后心肌梗死的影响。方法检索中文数据库(中国生物医学文献服务系统、中国知网、万方、维普)和英文数据库(Medline、PubMed、EBSCO、Springer、Ovid、Cochrane Library、Google scholar);收集椎管内阻滞对非心脏手术患者术后心肌梗死及死亡率影响的随机对照试验(RCT),并采用RevMan 5.3软件进行统计分析。结果共纳入10篇RCT(n=21 859)。Meta分析结果显示:EA复合GA与单纯GA非心脏手术术后7d内(OR=0.44,95%CI 0.13~1.46,P=0.18)和30d内(OR=1.49,95%CI 0.89~2.49,P=0.13)内心肌梗死发生率差异无统计学意义;EA复合GA与单纯GA术后30d内(OR=1.26,95%CI 0.84~1.88,P=0.26)全因死亡率差异无统计学意义。SA与GA术后7d内心肌梗死发生率(OR=1.14,95%CI 0.31~4.17,P=0.84)和术后30d内全因死亡率(OR=0.88,95%CI 0.43~1.79,P=0.73)差异无统计学意义。结论椎管内阻滞并未降低心脏事件高危患者行中高危非心脏手术后心肌梗死发生率及死亡率。Objective A meta-analysis was conducted to figure out the effects of anesthetic methods on postoperative myocardial infarction in noncardiac surgery patients.Methods We searched PubMed,Embase,Ovid,Cochrane Library,Google scholar,CNKI,Wang-fang data and VIP Database（by September 2016）to identify relevant studies that focused on the effect of intrathecal blockade on postoperative myocardial infarction and mortality in non-cardiac surgery.Meta-analysis was performed using software of RevMan 5.3.Results A total of 21 859 patients from 10 RCTs were enrolled.The meta-analysis showed that there were no differences in myocardial infarction within 7postoperative days（OR=0.44,95%CI 0.13-1.46,P=0.18）or 30days（OR=1.49,95%CI 0.89-2.49,P =0.13）and all-cause mortality（OR =1.26,95%CI 0.84-1.88,P =0.26）between epidural anesthesia combined with general anesthesia and general anesthesia.Furthermore,there were no differences in myocardial infarction within postoperative 7days（OR=1.14,95%CI 0.31-4.17,P=0.84）and all-cause mortality within postoperative 30days（OR=0.88,95%CI 0.43-1.79,P=0.73）between spinal anesthesia alone and general anesthesia alone.Conclusion Intrathecal blockade cannot affect the incidence of myocardial infarction and mortality in high-risk cardiac patients undergoing intermediate or high-risk non-cardiac surgery.

关 键 词：椎管内阻滞 非心脏手术 心肌梗死 死亡率 

分 类 号：R614[医药卫生—麻醉学]