国际麻醉学与复苏杂志   2017, Issue (5): 10-10
    
丙泊酚和七氟醚对成年患者校正QT间期影响的Meta分析
李惠, 高鸿, 赵艳, 林少峰, 王冬婷, 刘艳秋1()
1.贵州医科大学麻醉学院
Effect of propofol versus sevoflurane for corrected QT: a Meta-analysis
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摘要:

目的 系统性评价丙泊酚与七氟醚分别用于成年患者全身麻醉诱导时对ECG校正QT间期(corrected QT, QTc)的影响。 方法 计算机检索PubMed、Embase、Cochrane图书馆、中国知网、维普网等数据库的相关文献,并对相关文献的参考文献进行进一步的检索,收集七氟醚和丙泊酚用于成年人手术全身麻醉诱导的随机对照实验(randomized-controlled trial, RCT),采用Cochrane系统评价员手册评价纳入文献的质量,采用RevMan5.0软件对收集的资料进行Meta分析。 结果 纳入7项研究,共计313名患者,Meta分析结果显示:七氟醚与丙泊酚比较,具有明显的延长心肌复极时程的作用[加权均数差(weighted mean difference, WMD)=-23.53,95%CI(-30.57~-16.49)](P<0.01),但对于HR[(WMD=0.22,95%CI(-4.92~5.36)]及MAP[(WMD=-2.23,95%CI(-8.66~4.20)]的影响二者差异并无统计学意义(P>0.05)。 结论 与丙泊酚相比,七氟醚可明显延长心肌复极时程,增加心律失常发生的风险,且二者对于血流动力学的影响无明显差异,提示在麻醉诱导过程中,丙泊酚对于心脏电生理的影响较小,是一种良好的麻醉诱导药。

关键词: 丙泊酚; 七氟醚; 矫正QT间期; Meta 分析
Abstract:

Objective Systematic review the effect of propofol versus sevoflurane for corrected QT(QTc). Methods The PubMed, Embase, Cochrane Library, CNKI and VIP databases were searched to obtain studies concerning the effect of sevoflurane versus propofol on cardiac cardiac electrophysiology. The quality of studies were assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. After data extraction, Meta-analysis was performed with RevMan software 5.0. Results Three hundred and thirteen patients were involved in seven randomized-controlled trials (RCT) were used. The result of Meta-analysis shows that compared with myocardium repolarization time in propofol group, the duration of myocardium repolarize in sevoflurane group was prolonged obviously [(weighted mean difference, WMD)=-23.53, 95%CI(-30.57- -16.49)](P<0.01), but the parameters of HR[(WMD=0.22, 95%CI(-4.92-5.36)] and MAP[(WMD=-2.23, 95%CI(-8.66-4.20)] are not significantly different(P>0.05). Conclusions Compared with propofol, sevoflurane prolong the duration of myocardium repolarization, increase the risk of arrhythmia, but the parameters of haemodynamics between two groups showed no significant differences. The result demonstrated that in the process of anesthesia induction, the effects of propofol on cardiac electrophysiology is less and safer than sevoflurane.

Key words: Propofol; Sevoflurane; Corrected QT;  Meta-analysis