背景:甲状腺麻醉最常见的并发症是喉返神经损伤,麻醉药物对术中喉返神经监测指标的影响,尤其是神经阻滞剂,这会导致肌肉松弛和影响声带收缩。目的通过Meta分析探讨甲状腺手术中全身麻醉(GA)中罗库溴铵的最佳剂量。
方法:采用“甲状腺”组合检索中英文数据库“全身麻醉”,和“罗库溴铵”。包括以双倍剂量罗库溴铵GA手术为双组,以正常剂量罗库溴铵GA手术为正常组的出版物,采用审查经理5.3(RevMan5.3)进行荟萃分析。
结果:共有15篇出版物被纳入荟萃分析,并进行了总体异质性测试以获得结果。双组与正常组手术时间比较,均差(MD):20.93,95%置信区间(CI):(11.48,30.39)min,Z=4.34,I2=94%,P<0.0001,而双联组与正常组之间的出血量显示MD:-24.34,95%CI:(-28.11,-20.58)mL,Z=12.67,I2=91%,P<0.0001。双组与正常组引流量比较,MD:24.40,95%CI:(19.84,28.96)mL,Z=10.49,I2=68%,和P<0.0001,并且在双组和正常组之间的住院天数显示MD:-13.50,95%CI:(-18.02,-8.97)天,Z=5.85,I2=99%,P<0.0001。最后,双组与正常组满意度比较显示风险比(RR):2.16%,95%CI:(1.88%,2.48%),Z=10.91,I2=0,P<0.0001。使用RevMan5.3获取每个观察指标的漏斗图,一些出版物的圈子集中在中线和对称,表明研究的准确性很高,出版物中没有偏见。
结论:这项荟萃分析证实,双倍剂量的罗库溴铵可以满足甲状腺手术中麻醉诱导和GA的需要。
BACKGROUND: The most common complication of thyroid anesthesia is recurrent laryngeal nerve injury, and anesthesia drugs affect the intraoperative recurrent laryngeal nerve monitoring indicators, especially nerve blockers, which can cause muscle relaxation and affect vocal cord contraction. The purpose of this study was to investigate the optimal dose of rocuronium during general anesthesia (GA) during thyroid surgery by meta-analysis.
METHODS: Chinese and English databases were searched by the combination of \"thyroid\", \"general anesthesia\", and \"rocuronium bromide\". Publications which took double dose rocuronium GA surgery as the double group and normal dose rocuronium GA surgery as the normal group were included, and Review Manager 5.3 (Rev Man 5.3) was employed for meta-analysis.
RESULTS: A total of fifteen publications were included in the meta-analysis and an overall heterogeneity test was conducted to obtain the results. Comparison of the operation time between the double group and the normal group showed the mean difference (MD): 20.93, 95% confidence interval (CI): (11.48, 30.39) min, Z=4.34, I2=94%, and P<0.0001, while that of bleeding volume between the double group and the normal group showed the MD: -24.34, 95% CI: (-28.11, -20.58) mL, Z=12.67, I2=91%, and P<0.0001. Comparison of drainage volume between the double group and the normal group showed the MD: 24.40, 95% CI: (19.84, 28.96) mL, Z=10.49, I2=68%, and P<0.0001, and between hospitalization days between the double group and the normal group showed the MD: -13.50, 95% CI: (-18.02, -8.97) days, Z=5.85, I2=99%, and P<0.0001. Finally, comparison of satisfaction between the double group and the normal group showed risk ratio (RR): 2.16%, 95% CI: (1.88%, 2.48%), Z=10.91, I2=0, and P<0.0001. Rev Man 5.3 was employed to obtain the funnel chart of each observation indicator, and the circles of some publications were concentrated on the midline and symmetrical, indicating the research accuracy was high and there was no bias in the publications.
CONCLUSIONS: This meta-analysis confirmed that a double dose of rocuronium can meet the needs of anesthesia induction and GA during thyroid surgery.