基于ERAS和舒适化医疗理念下环泊酚与丙泊酚用于宫腔镜手术的Meta分析  

Meta-analysis of cypropofol versus propofol for hysteroscopic surgery based on ERAS and comfort medicine concepts

作　　者：罗富苹 黄跃 曾佳 阿苦果果 LUO Fuping;HUANG Yue;ZENG Jia;A Ku Guo Guo(Clinical Medical College,North Sichuan Medical College,Sichuan Nanchong 637000;Department of Anesthesia,North Sichuan Medical College,Sichuan Nanchong 637000;School of Civil Engineering and Architecture Southwest University of Science and Technology,Sichuan MianYang 621000;Department of Gynaecology and Obstetrics,Sichuan Academy of Medical Science·Sichuan Provincial People's Hospital,Sichuan Chengdu 610000a)

机构地区：[1]川北医学院临床医学院,四川南充637000 [2]川北医学院麻醉医学系,四川南充637000 [3]西南科技大学土木工程与建筑学院,四川绵阳621000 [4]四川省医学科学院四川人民医院妇产科,四川成都610000

出　　处：《新疆维吾尔医学专科学校学报》2024年第4期58-69,共12页

摘　　要：目的在ERAS和舒适化医疗理念下系统评价环泊酚与丙泊酚用于宫腔镜手术的疗效及安全性,为麻醉用药提供循证依据。方法两位研究者对自建库到2023年12月14日期间,在知网、万方、维普、中国生物医学文献服务系统、PubMed、Cochrane Library、Web of Science、Embase等数据库中发表的关于环泊酚与丙泊酚用于宫腔镜手术中的临床随机对照试验(RCT)进行文献筛选、资料提取及偏倚风险评估。采用RevMan 5.4软件进行Meta分析。结果最后纳入6项RCT,共计727例患者,环泊酚组391例,丙泊酚组336例。Meta分析结果显示,环泊酚与丙泊酚组在宫腔镜手术麻醉成功率(RR=1.00,95%CI:0.99~1.01,P=1)、苏醒时间(WMD=-0.02,95%CI:-0.73~0.69,P=0.96)、患者满意度(VMD=0.08,95%CI:-0.08~0.23,P=0.34)、恶心、呕吐发生率(RR=0.88,95%CI:0.34~2.27,P=0.80)、心动过缓发生率(RR=1.98,95%CI:0.88~4.47,P=0.10)方面差异无统计学意义;与丙泊酚相比,环泊酚在注射痛(RR=0.06,95%CI:0.03~0.11,P<0.05)、低血压(RR=0.55,95%CI:0.40~0.75,P<0.05)、呼吸抑制(RR=0.27,95%CI:0.13~0.57,P<0.05)不良反应发生率更低。结论环泊酚和丙泊酚均可用于宫腔镜手术的镇静中,均符合ERAS和舒适化医疗理念,具有苏醒时间快、麻醉成功率高、患者满意度好的优点。但相较于丙泊酚,环泊酚注射痛、低血压、呼吸抑制的发生率更低,用于宫腔镜手术镇静更具优势,更能实现高质量的门诊麻醉管理。Objective To systematically evaluate the efficacy and safety of ciprofol and propofol for hysteroscopic surgery under the concepts of ERAS and comfortable medical treatment,and to provide the evidence-based basis for anesthesia medication.Methods From the establishment of the database to De-cember 14,2023,the two researchers reviewed the data on PubMed,Cochrane Library,Web of Science,Embase,CNKI,Wanfang Data,VIP,and SinoMed.The clinical randomized controlled trials(RCTs)on cy-clopropyl and propofol in hysteroscopic surgery were independently screened,extracted,and assessed for risk of bias.Meta-analysis was performed using RevMan 5.4 software.Results Totally 6 RCTs involving 727 patients were included,including 391 in the ciprofol group and 336 in the propofol group.The results of the meta-analysis showed no significant difference in the success rate of anesthesia during hysteroscopic surgery(RR=1.00,95%CI:0.99~1.01,P=1),wake-up time(WMD=-0.02,95%CI:-0.73~0.69,P=0.96),patient satisfaction(VMD=0.08,95%CI:-0.08~0.23,P=0.34),and incidence of nausea and vomiting(RR=0.88,95%CI:0.34~2.27,P=0.80),bradycardia incidence(RR=1.98,95%CI:0.88~4.47,P=0.10).In terms of adverse effects,ciprofol had a lower incidence of injection pain(RR=0.06,95%CI:0.03~0.11,P<0.05),hypotension(RR=0.55,95%CI:0.40~0.75,P<0.05)and respiratory depression(RR=0.27,95%CI:0.13~0.57,P<0.05).Conclusion Both ciprofol and propofol can be used in the sedation of hys-teroscopic surgery,which is in line with ERAS and comfort medical concepts,and has the advantages of fast recovery time,a high success rate of anesthesia,and good patient satisfaction.However,compared with propofol,ciprofol injection has a lower incidence of painful pain,hypotension,and respiratory depres-sion,which has more advantages for sedation in hysteroscopic surgery and can achieve high-quality outpa-tient anesthesia management.

关 键 词：ERAS 舒适化医疗 环泊酚 丙泊酚 宫腔镜手术 META分析 

分 类 号：R713.4[医药卫生—妇产科学]