七氟醚对成人心脏手术体外循环中肺保护作用的Meta分析

摘要

Objective To assess the lung protection effect of sevoflurane on adult cardiac surgery during cardiopulmonary bypass (CPB) using Meta-analysis. Methods The databases of Cochrane library, Embase, PubMed, Google scholar,CNKI,Wanfang and Weipu were comprehensively searched by computer up to December 2017 to obtain the published literature on randomised controlled trials(RCT)of sevoflurane for lung protection under CPB.Key words included extracorporeal circulation, cardiac surgery, pulmonary protection, sevoflurane and Meta-analysis. And then a separate quality assessment and data extraction for the selected literatures were carried out by two researchers. The Meta-analysis was performed via statistical software RevMan5.3.Results Eleven RCT literatures and 440 patients in total were selected in this study, in which, 220 cases were for the sevoflurane group and 220 cases were for the total intravenous anesthesia (TIVA)group.The analysis results showed that the application of sevoflurane could significantly reduce the levels of IL-6 (P=0.005)and IL-8(P=0.01)in the blood,and decrease postoperative tracheal intubation time in CPB group compared with those of TIVA group(P<0.001).However,there were no statistical differences in the level of tumor necrosis factor-α(TNF-α) (P=0.19), the alveolar-arterial differences for oxygen[P(A-a)O2](P=0.68) and the oxygenation index OI between two groups (P=0.31). Conclusion The application of sevoflurane during CPB could effectively reduce the levels of some inflammatory factors in blood and decrease the postoperative tracheal intubation time. However, there is no adequate evidence to prove the definite lung protection effect of sevoflurane on CPB.%目的 用Meta分析的方法评估体外循环(CPB)下使用七氟醚对成人心脏手术患者的肺保护作用.方法 用计算机全面检索Cochrane library、Embase、PubMed、Google scholar、中国知网、万方、维普等数据库,检索的关键词包括:体外循环、心脏手术、肺保护、七氟醚Meta分析.检索时间截止为2017年12月.获取公开发表的有关在CPB下七氟醚对肺保护的随机对照试验(RCT)的文献.由2位研究者单独对入选文献进行质量评价和数据提取,利用RevMan5.3进行Meta分析.结果 共入选11篇RCT文献,440例患者,其中七氟醚组220例、全凭静脉麻醉(TIVA)组220例.结果显示,与TIVA组相比,CPB中使用七氟醚可以有效降低患者血液中白细胞介素(IL)-6(P=0.005)和IL-8浓度(P=0.01),减少术后气管插管时间(P<0.001).但是2组间肿瘤坏死因子-α(TNF-α)浓度(P=0.19)、肺泡-动脉血氧分压差[P(A-a)O2](P=0.68)和氧合指数OI(P=0.31)差异无统计学意义.结论 在CPB期间使用七氟醚能够有效降低患者血液中部分炎性因子的浓度,减少术后气管插管时间,但尚无足够证据证明在CPB中用七氟醚具有确切的肺保护作用.