胸段硬膜外阻滞对冠脉搭桥术预后影响的系统评价

目的系统评价胸段硬膜外阻滞对冠脉搭桥术预后的影响。方法电子检索PubMed、EBSCO、Springer、Ovid、CNKI等数据库,纳入1990～2009年间关于冠脉搭桥手术行胸段硬膜外阻滞联合全麻和传统的单纯全麻预后比较的RCT,按Cochrane系统评价方法对纳入文献进行质量评价和资料提取,采用RevMan软件进行Meta分析。结果共纳入16篇RCT,包括1？316例患者。Meta分析结果显示：胸段硬膜外阻滞联合全麻与传统单纯全麻相比,术后拔气管插管时间缩短MD=–332.43,95%CI（–640.19,–24.68）,P=0.03],术后第一天静息疼痛VASMD=？–1.23,95%CI（–2.19,–0.27）,P=0.01]、术后第一天运动疼痛VASMD=？–2.52,95%CI（–4.65,–0.39）,P=0.02]和术后第二天运动疼痛VASMD=？–1.5,95%CI（–2.56,–0.43）,P=0.006]降低,术后心肌缺血发生率降低RR=0.53,95%CI（0.29,0.97）,P=0.04];而在术后心梗、房颤发生率、死亡率和肺功能方面两组间差异无统计学意义。结论冠脉搭桥手术行胸段硬膜外阻滞联合全麻较传统的单纯全麻能明显缩短术后拔气管插管时间,明显降低术后疼痛VAS,降低术后心肌缺血发生率。对于术后心梗、房颤发生率,死亡率和肺功能的影响尚需开展更多深入研究来证实。

Effects of Thoracic Epidural Anesthesia on Outcome after Coronary Artery Bypass Surgery: A Systematic Review

Objective To systematically evaluate the effects of thoracic epidural anesthesia on outcome after coronary artery bypass surgery.Methods We searched PubMed,EBSCO,Springer,Ovid,and CNKI databases from 1990 through Oct.2009 to identify randomized controlled trials（RCTs）about thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone on outcome after coronary artery bypass surgery.The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Reviewer＇s Handbook.The homogeneous RCTs were pooled using RavMan 4.2.10 software.Results Sixteen RCTs involving 1 316 patients met the inclusion criteria.The results of meta-analyses showed that thoracic epidural anesthesia significantly reduced time to tracheal extubation（MD= –332.43,95%CI –640.19 to –24.68,P=0.03）,visual analog scale（VAS）scores at rest on postoperation day 1（MD= –1.23,95%CI –2.19 to –0.27,P=0.01）,VAS scores with movement on postoperation day 1（MD= –2.52,95%CI –4.65 to –0.39,P=0.02）and day 2（MD= –1.5,95%CI –2.56 to –0.43,P=0.006）,and incidences of myocardial ischemia（RR=0.53,95%CI 0.29 to 0.97,P=0.04）.There were no significant differences between the two groups in postoperative pulmonary function,incidences of myocardial infarction,atrial fibrillation,and mortality.Conclusions Thoracic epidural anesthesia could reduce postoperative time to tracheal extubation,VAS score,and incidences of myocardial ischemia,but it does not affect postoperative pulmonary function,incidences of myocardial infarction,atrial fibrillation,and mortality.More high-quality RCTs are required.