胸段硬外麻复合全麻对单肺通气病人肺内分流的系统评价

目的系统评价胸段硬外麻复合全麻与单纯全麻对单肺通气（OLV）病人肺内分流的影响。方法计算机检索Cochrane Library（2009年第4期）、Cochrane协作网麻醉组数据库、PubMed（1966～2009.12）、EMbase（1966～2009.12）、中国生物医学文献数据库（CBM,1978～2009.12）、维普中文期刊数据库（VIP,1989～2009.12）、清华同方（CNKI,1915～2009.12）,手工检索《临床麻醉学杂志》、《中华麻醉学杂志》,收集胸段硬外麻复合全麻与单纯全麻对单肺通气病人肺内分流的随机对照试验,由两名评价员独立进行试验筛选、资料提取和质量评价,并采用RevMan 5.0软件进行Meta分析。结果共纳入10个研究,包括506例患者。Meta分析结果显示,在OLV后5、15、20、30及60 min几个时点,两组肺内分流差异均无统计学意义。结论胸段硬外麻复合全麻与单纯全麻均可安全用于OLV胸科手术患者。但由于纳入研究的方法学质量不高,病例数较少,因此尚需开展更多高质量、大样本的随机对照试验进一步评价。

Effects of Thoracic Epidural Anesthesia Combined with General Anesthesia on Arterial Oxygenation and Intrapulmonary Shunting during One-Lung Ventilation:A Systematic Review

Objective To evaluate the effectiveness of thoracic epidural anesthesia（TEA） combined with general anesthesia（GA） versus GA alone on intrapulmonary shunting during one-lung ventilation（OLV）.Methods We searched the Cochrane Library（Issue 4,2009）,the specialized trials registered in the Cochrane anesthesia group,PubMed（1966 to Dec.2009）,EMbase（1966 to Dec.2008）,CBM（1978 to Dec.2009）,VIP（1989 to Dec.2009）,CNKI（1915 to Dec.2009）,and handsearched Clinical Anesthesia Journal and Chinese Anesthesia Journal.Randomized controlled trials（RCTs） about the effectiveness of TEA combined with GA versus GA alone on intrapulmonary shunting during OLV were included,The methodological quality of included RCTs was evaluated by two reviewers independently,Meta-analysis was conducted using RevMan 5.0 software.Results Ten RCTs involving 506 patients were included.The results of meta-analyses showed that there were no significant differences in intrapulmonary shunting during OLV at different times-points of 5,15,20,30,and 60 minutes after OLV.Conclusion Both TEA combined with GA and GA alone have the same Security during OLV.But owing to the low quality and small sample size of the included studies,further more well-designed,large sample size RCTs are needed.