目的:这项荟萃分析旨在比较异丙酚和挥发性麻醉在开颅手术期间脑肿胀的风险。
方法:随机对照试验(RCTs)的Meta分析。
方法:手术室。
方法:丙泊酚麻醉。
方法:接受开颅手术的成年患者。
方法:数据库,包括EMBASE,MEDLINE,谷歌学者,和Cochrane图书馆,从成立之初到2023年4月进行了搜索。主要结果是脑肿胀的风险,次要结局包括麻醉方案对手术和恢复结局的影响,以及血流动力学不稳定的风险。
结果:我们对17项随机对照试验的荟萃分析表明,脑肿胀的风险显着降低(风险比[RR]:0.85,p=0.03,I2=21%,n=1976)在接受异丙酚的患者中,两组在手术时间和失血量方面无显著差异。此外,异丙酚与较低的颅内压(ICP)相关(平均差:-4.06mmHg,p<0.00001,I2=44%,n=409)以及较低的心动过速风险(RR=0.54,p=0.005,I2=0%,n=822)和术后恶心/呕吐(PONV)(RR=0.59,p=0.002,I2=19%,n=1382)。其他恢复结果没有显著差异(例如,拔管时间),心动过缓的风险,高血压,或低血压在两组之间。亚组分析表明,与单独的挥发性药物相比,异丙酚与脑肿胀风险降低无关。按开颅手术适应症分层,异丙酚减少选择性开颅手术中的脑肿胀,但不是在紧急开颅手术中(例如,创伤性脑损伤),与挥发性麻醉剂相比。
结论:通过回顾现有证据,我们的结果证明了异丙酚对脑肿胀风险的有益作用,ICP,PONV,术中心动过速.在颅脑外伤和蛛网膜下腔出血的急诊开颅手术中,丙泊酚和挥发性药物之间的脑肿胀没有显着差异。需要进一步的大规模研究进行验证。
This meta-analysis aimed to compare the risk of brain swelling during craniotomy between propofol-based and volatile-based anesthesia.
Meta-analysis of randomized controlled trials (RCTs).
Operating room.
Propofol-based anesthesia.
Adult patients undergoing craniotomy.
Databases, including EMBASE, MEDLINE, Google Scholar, and Cochrane Library, were searched from inception to April 2023. The primary outcome was the risk of brain swelling, while the secondary outcomes included the impact of anesthetic regimens on surgical and recovery outcomes, as well as the risk of hemodynamic instability.
Our meta-analysis of 17 RCTs showed a significantly lower risk of brain swelling (risk ratio [RR]: 0.85, p = 0.03, I2 = 21%, n = 1976) in patients receiving propofol than in those using volatile agents, without significant differences in surgical time or blood loss between the two groups. Moreover, propofol was associated with a lower intracranial pressure (ICP) (mean difference: -4.06 mmHg, p < 0.00001, I2 = 44%, n = 409) as well as a lower risk of tachycardia (RR = 0.54, p = 0.005, I2 = 0%, n = 822) and postoperative nausea/vomiting (PONV) (RR = 0.59, p = 0.002, I2 = 19%, n = 1382). There were no significant differences in other recovery outcomes (e.g., extubation time), risk of bradycardia, hypertension, or hypotension between the two groups. Subgroup analysis indicated that propofol was not associated with a reduced risk of brain swelling when compared to individual volatile agents. Stratified by craniotomy indications, propofol reduced brain swelling in elective craniotomy, but not in emergency craniotomy (e.g., traumatic brain injury), when compared to volatile anesthetics.
By reviewing the available evidence, our results demonstrate the beneficial effects of propofol on the risk of brain swelling, ICP, PONV, and intraoperative tachycardia. In emergency craniotomy for traumatic brain injury and subarachnoid hemorrhage, brain swelling showed no significant difference between propofol and volatile agents. Further large-scale studies are warranted for verification.