目的:延长心脏复极,尤其是心率校正QT(QTc)间期,与危及生命的节律紊乱有关.本研究旨在确定延长心脏复极风险最低的麻醉剂,并为心脏病或长QT综合征患者的麻醉管理提供指导。
方法:在多个数据库中搜索比较麻醉药对心脏复极指标影响的随机对照试验(RCT)。主要结局是QTc;次要结局是其他复极指标。使用频率方法进行网络荟萃分析,并在国际前瞻性系统审查注册(PROSPERO)数据库(CRD42022304970)中注册。
结果:纳入了13项RCT,调查了953名QTc间期正常且无心血管疾病的成年人。直接荟萃分析发现,异丙酚的影响小于七氟醚(95%置信区间(CI):16.10,33.54)和地氟醚(95%CI:4.85,35.36)。七氟醚对QTc延长的影响小于地氟醚(95%CI:6.96,19.39)。网络分析发现异丙酚的影响小于七氟醚(95%CI:17.78,29.63),氟烷(95%CI:11.29,41.24),地氟醚(95%CI:23.79,39.88),和异氟烷(95%CI:20.11,46.10),七氟醚对QTc延长的影响小于地氟醚(95%CI:0.43,15.82)。累积排序曲线分析的排序顺序为异丙酚(100%),七氟醚(63.8%),氟烷(49.5%),地氟烷(21.1%),和异氟烷(15.6%)。直接荟萃分析发现,异丙酚对QT延长的影响小于七氟醚(95%CI:23.12,57.86)。其他次要结果没有结论性发现。
结论:这项荟萃分析发现,异丙酚对QTc延长的影响很小,QTc间期正常且无心血管疾病的成人依次为七氟醚和地氟醚。丙泊酚是成人长QT综合征或心脏病患者的最佳麻醉剂,但仍需要更有力的证据.
OBJECTIVE: Prolongation of cardiac repolarization, especially the heart rate-corrected QT (QTc) interval, is associated with life-threatening dysrhythmias. This study aimed to identify the anesthetic with the lowest risk of prolonging cardiac repolarization and provide guidance for anesthesia management in patients with cardiac diseases or long QT syndrome.
METHODS: Randomized controlled trials (RCTs) comparing the effects of anesthetics on cardiac repolarization indices were searched for in multiple databases. The primary outcome was QTc; and the secondary outcomes were other repolarization indices. A network meta-analysis was conducted using a frequentist approach and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022304970).
RESULTS: Thirteen RCTs investigating 953 adults with normal QTc interval and without cardiovascular diseases were included. Direct meta-analyses found that propofol had less influence than sevoflurane (95% confidence interval (CI): 16.10, 33.54) and desflurane (95% CI: 4.85, 35.36), and sevoflurane had less influence than desflurane (95% CI: 6.96, 19.39) on QTc prolongation. Network analysis found that propofol had less influence than sevoflurane (95% CI: 17.78, 29.63),
halothane (95% CI: 11.29, 41.24), desflurane (95% CI: 23.79, 39.88), and isoflurane (95% CI: 20.11, 46.10), and sevoflurane had less influence than desflurane (95% CI: 0.43, 15.82) on QTc prolongation. The rank order of cumulative ranking curve analysis was propofol (100%), sevoflurane (63.8%),
halothane (49.5%), desflurane (21.1%), and isoflurane (15.6%). The direct meta-analysis found that propofol had less influence than sevoflurane on QT prolongation (95% CI: 23.12, 57.86). Other secondary outcomes showed no conclusive findings.
CONCLUSIONS: This meta-analysis found that propofol had a minimal effect on QTc prolongation, followed by sevoflurane and desflurane in adults with normal QTc interval and without cardiovascular diseases. Propofol is the best anesthetic for adult patients with long QT syndrome or cardiac diseases, but still needs more robust evidence.