本文選題：七氟醚 + 丙泊酚�。� 參考：《蘭州大學(xué)》2014年碩士論文

【摘要】：研究目的 七氟醚因具有誘導(dǎo)時(shí)間短、蘇醒快、麻醉平穩(wěn)的特點(diǎn),廣泛應(yīng)用于兒科麻醉。丙泊酚是目前臨床上使用最廣泛的靜脈麻醉藥,靜脈注射后起效快,蘇醒質(zhì)量高。大量研究發(fā)現(xiàn),七氟醚麻醉后小兒躁動(dòng)發(fā)生率較高,亦有一部分研究顯示,七氟醚和丙泊酚兩種麻醉方式下沒(méi)有差異。但七氟醚吸入麻醉后小兒躁動(dòng)的研究尚缺乏高質(zhì)量循證醫(yī)學(xué)證據(jù)。近年來(lái),關(guān)于氙氣與其他麻醉藥物比較的臨床研究逐漸增多,對(duì)于手術(shù)時(shí)間較長(zhǎng),蘇醒速度有要求的病人,氙氣具有潛在的臨床價(jià)值。因此,本研究分為兩部分,采用Meta分析方法分別評(píng)價(jià)：(1)七氟醚吸入麻醉和丙泊酚靜脈麻醉后對(duì)小兒躁動(dòng)的影響,旨在為患兒圍手術(shù)期麻醉方案的制定提供臨床依據(jù)；(2)研究比較氙氣和七氟醚的蘇醒特征,并與臨床使用最多的異氟醚進(jìn)行比較,研究其各自的優(yōu)缺點(diǎn)。 研究方法 1.計(jì)算機(jī)檢索PubMed(1966-2012.12).EMbase(1974-2012.12).Web of science(1945-2012.12).The Cochrane Library(2012年第4期)、CBM(1978-2012.12).CNKI(1979-2012.12).萬(wàn)方數(shù)據(jù)庫(kù)(1998-2012.12)和維普數(shù)據(jù)庫(kù)(1989-2012.12)。納入比較七氟醚和丙泊酚麻醉影響小兒術(shù)后躁動(dòng)的隨機(jī)對(duì)照試驗(yàn)(RCT)；納入比較氙氣和異氟醚、氙氣和七氟醚麻醉后蘇醒特征的隨機(jī)對(duì)照試驗(yàn)；追溯納入研究的參考文獻(xiàn)。 2.由兩位研究者按照納入與排除標(biāo)準(zhǔn)獨(dú)立篩選文獻(xiàn)、提取資料、使用Cochrane系統(tǒng)評(píng)價(jià)方法評(píng)價(jià)納入研究的方法學(xué)質(zhì)量。 3.用RevMan5.1.7軟件進(jìn)行Meta分析,評(píng)價(jià)七氟醚和丙泊酚麻醉影響小兒術(shù)后躁動(dòng)發(fā)生情況,研究比較氙氣和七氟醚的蘇醒特征。 研究結(jié)果 1.比較七氟醚和丙泊酚對(duì)小兒術(shù)后躁動(dòng)的研究共納入9個(gè)隨機(jī)對(duì)照試驗(yàn),Meta分析合成6個(gè),共計(jì)692例患兒。Meta分析結(jié)果顯示：①經(jīng)七氟醚誘導(dǎo)后,丙泊酚維持組的躁動(dòng)發(fā)生率低于七氟醚維持組[RR=0.57,95%CI(0.39,0.84)]；②全憑丙泊酚靜脈麻醉組的躁動(dòng)發(fā)生率低于全憑七氟醚吸入麻醉組[RR=0.16,95%CI(0.06,0.39)]。 2.比較氙氣和七氟醚的蘇醒特征的研究納入6個(gè)隨機(jī)對(duì)照試驗(yàn),共計(jì)449例患者。Meta分析結(jié)果顯示：①與異氟醚相比,氙氣麻醉后睜眼時(shí)間較短[SMD=-1.07,95%CI(-1.31,-0.82)](SMD:標(biāo)準(zhǔn)化均數(shù)差)；拔管時(shí)間較短[SMD=-2.04,95%CI(-3.30,-0.78)];5分鐘后Aldrete評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異[SMD=3.34,95%CI(-0.49,6.76)]。②與七氟醚相比,氙氣麻醉后睜眼時(shí)間較短[SMD=-1.54,95%CI(-2.00,-1.07)];拔管時(shí)間較短[SMD=-3.72,95%CI(-4.90,-2.55)]；恢復(fù)方向感時(shí)間較短[SMD=-2.20,95%CI(-3.84,-0.56)];恢復(fù)倒數(shù)數(shù)字時(shí)間較短[SMD=-1.07,95%CI(-1.31,-0.82)]; PONV發(fā)生率沒(méi)有統(tǒng)計(jì)學(xué)差異[RR=1.26,95%CI(0.67,-2.38)]。 研究結(jié)論 Meta分析結(jié)果表明：(1)七氟醚麻醉小兒術(shù)后躁動(dòng)發(fā)生率高于丙泊酚麻醉,相比七氟醚,小兒父母對(duì)丙泊酚麻醉的滿意度更高。(2)相比異氟醚和七氟醚麻醉,氙氣麻醉后蘇醒迅速；氙氣和異氟醚麻醉后的病人的Aldrete評(píng)分沒(méi)有區(qū)別；氙氣和七氟醚麻醉PONV發(fā)生率沒(méi)有區(qū)別,氙氣麻醉術(shù)后認(rèn)知能力恢復(fù)較早。受納入研究數(shù)量與質(zhì)量的限制,臨床上在選擇麻醉方式之前,應(yīng)該對(duì)患兒的各方面情況進(jìn)行綜合考慮。
[Abstract]:research objective
Sevoflurane is widely used in pediatric anesthesia because of its short induction time, quick revival and smooth anesthesia. Propofol is the most widely used intravenous anesthetic at present. After intravenous injection, the effect is fast and the quality of awakening is high. A large number of studies have found that the incidence of manic activity in children after sevoflurane anesthesia is high, and some studies have shown sevoflurane. There is no difference between the two methods of anaesthesia with propofol. However, the study of agitation in children after sevoflurane inhalation is still lack of evidence of high quality evidence-based medicine. In recent years, the clinical study of xenon with other anesthetics has increased gradually, and xenon has a potential clinical value for patients with a longer operation time and a demanding recovery. Therefore, the study is divided into two parts. The Meta analysis method is used to evaluate the effects of sevoflurane inhalation and propofol intravenous anesthesia on children's restlessness. The purpose is to provide clinical basis for the formulation of perioperative anesthesia for children. (2) compare the revival characteristics of xenon and seven fluoro ether, and the most clinical use of isoflurane. Compare their respective advantages and disadvantages.
research method
1. computer retrieves PubMed (1966-2012.12).EMbase (1974-2012.12).Web of Science (1945-2012.12).The Cochrane Library (2012 fourth). A randomized controlled trial involving the comparison of xeno and isoflurane, xenon and sevoflurane anaesthesia after induction of anesthesia was included in the study (RCT).
2. two researchers independently screened the literature according to inclusion and exclusion criteria, extracted data, and evaluated the methodological quality of the included studies using Cochrane system evaluation.
3. Meta analysis was carried out by RevMan5.1.7 software to evaluate the effects of sevoflurane and propofol on the postoperative agitation of children, and to compare the revival characteristics of xenon and sevoflurane.
The results of the study
1. a total of 9 randomized controlled trials were included in the study of postoperative agitation of children with sevoflurane and propofol. 6 were synthesized by Meta analysis. The results of.Meta analysis in a total of 692 children showed that after sevoflurane induction, the incidence of agitation in the propofol maintenance group was lower than that of the maintenance group of sevoflurane ([RR= 0.57,95%CI (0.39,0.84)); The incidence of restlessness in intoxicated group was lower than that in sevoflurane inhalation anesthesia group [RR=0.16,95%CI (0.06,0.39)].
2. comparison of the revival characteristics of xenon and sevoflurane was included in 6 randomized controlled trials. A total of 449 patients with.Meta analysis showed that: 1. Compared with isoflurane, the opening time after xenon anesthesia was shorter [SMD=-1.07,95%CI (-1.31, -0.82)) (SMD: standardized mean number difference); the extubation time was shorter [SMD=-2.04,95%CI (-3.30, -0.78)); 5 minutes later Aldre There was no statistical difference in te ([SMD=3.34,95%CI (-0.49,6.76)). Compared with sevoflurane, the opening time of xenon was shorter [SMD=-1.54,95%CI (-2.00, -1.07)); the extubation time was shorter [SMD=-3.72,95%CI (-4.90, -2.55)); the recovery time was shorter than [SMD=-2.20,95%CI (-3.84, -0.56)]; .31, -0.82)] there was no significant difference in the incidence of PONV ([RR=1.26,95%CI (0.67, -2.38)].
research conclusion
The results of Meta analysis showed that: (1) the incidence of agitation in children after sevoflurane anesthesia was higher than that of propofol. Compared with sevoflurane, children's parents were more satisfied with propofol anesthesia. (2) compared to isoflurane and sevoflurane anaesthesia, xenon anaesthesia was rapid and the xenon and isoflurane anesthetized patients had no difference in Aldrete score; xenon gas. There is no difference between the incidence of PONV in sevoflurane anesthesia and the early recovery of cognitive ability after xenon anesthesia. Limited by the quantity and quality of the study, the clinical situation should be considered in all aspects of the children before choosing the way of anesthesia.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R614.2

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本文編號(hào)：1773305