瑞马唑仑在纤维支气管镜检查中有效性与安全性的荟萃分析  

Safety and efficacy of remimazolam in fiberoptic bronchoscopy:A Meta-analysis

作　　者：许云鹏 周家来 郑家怡 李红瑞 郭鸿[3] 刘健 Xu Yunpeng;Zhou Jialai;Zheng Jiayi;Li Hongrui;Guo Hong;Liu Jian(The First Clinical Medical School,Lanzhou University,Lanzhou 730000,China;The Second Clinical Medical School,Lanzhou University,Lanzhou 730000,China;Department of ICU,The First Hospital of Lanzhou University,Lanzhou 730000,China;Gansu Province Maternity and Child-Care Hospital(Gansu Provincial Central Hospital),Lanzhou 730070,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第二临床医学院,甘肃兰州730000 [3]兰州大学第一医院重症医学科,甘肃兰州730000 [4]甘肃省妇幼保健院(甘肃省中心医院),甘肃兰州730070

出　　处：《兰州大学学报（医学版）》2024年第1期61-66,共6页Journal of Lanzhou University（Medical Sciences）

基　　金：国家重点研发资助项目(2022YFC2504505);中国卫生信息与健康医疗大数据学会资助项目(Z-2019-1-002);甘肃省重点研发资助项目(20YF8FA082);甘肃省中医药科研资助项目(GZKP-2021-27);兰州大学第一医院院内基金资助项目(ldyyyn2019-66);兰州大学学生创新创业行动计划资助项目(20230060168)。

摘　　要：目的系统评价瑞马唑仑与丙泊酚在纤维支气管镜检查中安全性和有效性的差异。方法计算机检索PubMed、Embase、Cochrane、Web ofScience、中国知识基础设施工程、万方数据库、中国生物医学数据库、维普数据库等数据库,检索时限为建库至2023年6月,采用Revman 5.4软件进行Meta分析。结果初检137篇文献,经过筛选最终纳入6篇符合标准的文献,Meta分析结果显示,丙泊酚与瑞马唑仑麻醉诱导时间(MD=0.35,95%CI:[-0.07,0.77],P=0.10)、麻醉苏醒时间(MD=1.29,95%CI:[-1.35,3.94],P=0.34)、检查时间(MD=-0.66,95%CI:[-1.58,0.26],P=0.16)及麻醉满意度(MD=-0.13,95%CI:[-0.46,0.20],P=0.43)差异无统计学意义。与丙泊酚比较,瑞马唑仑麻醉诱导前后心率(MD=3.75,95%CI:[0.57,6.92],P=0.02)、收缩压(MD=18.21,95%CI:[6.24,30.17],P=0.003)、舒张压差值降低(MD=12.13,95%CI:[6.19,18.07],P<0.0001)。2组麻醉诱导前后平均动脉压差值比较无统计学意义(MD=-0.91,95%CI:[-28.04,26.22],P=0.95)。与丙泊酚比较,瑞马唑仑组低血压发生率降低(OR=0.31,95%CI:[0.21,0.47],P<0.0001);2组总不良反应(OR=0.21,95%CI:[0.04,1.12],P=0.07)、注射痛(OR=0.10,95%CI:[0.01,1.72],P=0.11)、呼吸抑制(OR=0.50,95%CI:[0.06,3.83],P=0.50)、恶心呕吐(OR=0.98,95%CI:[0.11,8.94],P=0.98)、心动过缓及体动发生率(OR=0.62,95%CI:[0.21,1.90],P=0.41;OR=1.79,95%CI:[0.51,6.23],P=0.36)差异无统计学意义。结论在支气管镜检查中,瑞马唑仑与丙泊酚效果相当,血流动力学更稳定,不良反应发生率更低。Objective To systematically evaluate the differences in safety and effectiveness between remimazolam and propofol in fiberoptic bronchoscopy.Methods A computerized search was conducted in databases including PubMed,Embase,Cochrane,Web of Science,China National Knowledge Infrastructure,Wanfang Data,China Biomedical Database and VIP Database,covering all records up to June 2023.A meta-analysis was performed using Revman 5.4 software.Results Out of 137 initially identified publications,6 studies meeting the criteria were included in the final analysis.The meta-analysis showed no significant difference between propofol and remimazolam in terms of anesthesia induction time(MD=0.35,95%CI:[-0.07,0.77],P=0.1),anesthesia recovery time(MD=1.29,95%CI:[-1.35,3.94],P=0.34),examination duration(MD=-0.66,95%CI:[-1.58,0.26],P=0.16)and anesthesia satisfaction(MD=-0.13,95%CI:[-0.46,0.20],P=0.43).Compared with propofol,remimazolam showed a decrease in heart rate(MD=3.75,95%CI:[0.57,6.92],P=0.02),systolic blood pressure(MD=18.21,95%CI:[6.24,30.17],P=0.003)and diastolic pressure difference(MD=12.13,95%CI:[6.19,18.07],P<0.0001)before and after anesthesia induction.No significant difference was found between the two groups in the mean arterial pressure before and after anesthesia induction(MD=-0.91,95%CI:[-28.04,26.22],P=0.95).Compared with propofol,the incidence of hypotension in the remimazolam group was lower(OR=0.31,95%CI:[0.21,0.47],P<0.0001).And there was no significant difference in the overall adverse reactions(OR=0.21,95%CI:[0.04,1.12],P=0.07),injection pain(OR=0.10,95%CI:[0.01,1.72],P=0.11),respiratory depression(OR=0.50,95%CI:[0.06,3.83],P=0.50),nausea and vomiting(OR=0.98,95%CI:[0.11,8.94],P=0.98),bradycardia and physical movement(OR=0.62,95%CI:[0.21,1.90],P=0.41;OR=1.79,95%CI:[0.51,6.23],P=0.36)between the two groups.Conclusion In bronchoscopy,remimazolam and propofol are equally effective,with the former showing more stable hemodynamics and a lower incidence of adverse reactions.

关 键 词：瑞马唑仑 丙泊酚纤维支气管镜检查 安全性 有效性 META分析 麻醉 不良反应 

分 类 号：R541[医药卫生—心血管疾病]