全凭静脉麻醉维持期BIS指导下丙泊酚闭环与开环靶控输注效果比较的Meta分析

摘要

Objective To systematical assess the efficacy of closed-loop target-controlled infusion (TCI) of propofol and open-loop TCI of propofol under the guidance of Bispectral index (BIS) during the maintenance phase of total intravenous anesthesia.Methods We screened PubMED, Web of Science, EMBASE, the Cochrane Library, CNKI, VIP, WanFang, and CDMD to identify the randomized controlled trials (RCTs) on the efficacy of propofol with closed-loop TCI versus open-loop TCI under the guidance of BIS in the total intravenous anesthesia.The included trials were evaluated by using the Cochrane Collaboration's tool.The meta-analysis was conducted by using Revman5.0.Results Six eligible RCTs involving 680 patients were identified in our meta-analysis, including 341 cases of closed-loop TCI (closed-loop group) and 339 cases of open-loop TCI (open-loop group).The percentage of full anesthesia time in the total anesthesia of the closed-loop group was higher than that in the open-loop group (WMD=12.68, 95% CI 7.92-17.43, P<0.01).The percentage of light anesthesia duration in the total anesthesia was lower than that of the open-loop group (WMD=-1.38, 95% CI: from-2.24 to-0.51, P<0.01).The percentage of deep anesthesia duration in the total anesthesia was lower than that of the open-loop group (WMD=-9.80, 95% CI: from-18.51 to-1.09, P<0.05).The propofol dosage was significantly less than that of the open-loop group (WMD=-0.28, 95% CI: from-0.53 to-0.03, P<0.05).There was no statistically significant difference in the incidence of physical reaction between the two groups (RR=0.98, 95%CI:0.58-1.68, P=0.95), as well as in the postoperative extubated time between the two groups (WMD=-1.36, 95% CI: from-2.69 to-0.02, P=0.05).Conclusion Compared with open-loop TCI, during the maintenance phase, the closed-loop TCI could control the depth of anesthesia more accurately, and it could significantly reduce the dosage of propofol.%目的 系统评价全凭静脉麻醉维持期脑电双频谱指数(BIS)指导下丙泊酚闭环靶控输注(TCI)和开环TCI的效果.方法 检索Pubmed、Web of Science、EMBASE、Cochrane图书馆、CNKI、VIP、万方和中国优秀博硕士学位论文全文数据库,纳入BIS指导下丙泊酚闭环TCI对比开环TCI在全凭静脉麻醉中应用的临床随机对照研究.采用Cochranne协作网系统评价法评价纳入文献的质量,采用Revman5.0软件对纳入文献的数据进行Meta分析.结果 纳入6篇研究共680例患者,其中闭环TCI 341例(闭环组),开环TCI 339例(开环组).闭环组充分麻醉时间占麻醉总时间的百分比高于开环组(WMD=12.68,95% CI为7.92~17.43,P<0.01),浅麻醉持续时间占麻醉总时间的百分比低于开环组(WMD=-1.38,95% CI为-2.24~-0.51,P<0.01),深麻醉持续时间占麻醉总时间的百分比低于开环组(WMD=-9.80,95% CI为-18.51~-1.09,P<0.05);麻醉维持期丙泊酚用量明显少于开环组(WMD=-0.28,95% CI为-0.53~-0.03,P<0.05 ).两组术中体动反应发生率比较差异无统计学意义(RR=0.98,95%CI为0.58~1.68,P=0.95),术后拔管时间比较差异无统计学意义(WMD=-1.36,95% CI为-2.69~-0.02,P=0.05).结论 全凭静脉麻醉维持期闭环TCI对麻醉深度的控制好于开环TCI,且可减少药物用量.