全身麻醉期间瑞马唑仑和异丙酚对血液动力学影响的比较:系统综述和荟萃分析。

IF 2.9 3区 医学 Q1 ANESTHESIOLOGY
Minerva anestesiologica Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI:10.23736/S0375-9393.24.18041-8
Bruno M Wegner, Gustavo M Wegner, Luigi W Spagnol, Luis A Costa, Valentine W Spagnol, Daniel F Paiva
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引用次数: 0

摘要

简介由于需要副作用极小的安全麻醉剂,人们开发出了一种新型苯二氮卓类药物--瑞马唑仑(remimazolam),旨在替代对血液动力学有显著影响的常用药物异丙酚。本研究旨在比较雷马唑仑与异丙酚在全身麻醉过程中的血液动力学效应:按照 Cochrane 手册和 PRISMA 声明的建议,于 2023 年 2 月 13 日在 Embase、Web of Science、Cochrane Library、Scopus 和 PubMed 数据库中进行了系统检索。相关性的衡量标准是风险比(RR)或标准化平均差,以及 95% 置信区间(CI)和 95% 预测区间(PI)。2023 年 9 月 4 日又进行了一次检索。根据编辑建议,进行了试验序列分析和 GRADE(建议评估、发展和评价分级)证据表:在应用资格标准并去除重复数据后,16 项随机临床试验(共 1951 名患者)被纳入荟萃分析。在以下方面观察到瑞咪唑安定优于异丙酚的显著相关性:术中低血压事件(RR=0.47;95% CI=0.41~0.54;95% PI=0.40~0.55);血管活性药物给药频率(RR=0.54;95% CI=0.46~0.64;95% PI=0.41~0.74);术中心动过缓(RR=0.39;95% CI=0.27至0.57;95% PI=0.26至0.66);诱导时平均动脉压(MD=7.77;95% CI=6.00至9.55;95% PI=4.39至11.15);诱导时心率(MD=6.40;95% CI=4.07~8.73;95% PI=0.33~12.48);插管时的心率(MD=6.06;95% CI=2.33~9.78;95% PI=-5.59~17.71).结论:本研究提供的证据表明,与异丙酚相比,瑞马唑仑在全身麻醉过程中诱发的心肺抑制作用更少,副作用也更小。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison between hemodynamic effects of remimazolam and propofol during general anesthesia: a systematic review and meta-analysis.

Introduction: The need for safe anesthetic agents with minimal side effects has led to the development of remimazolam, a new benzodiazepine designed to be an alternative to the commonly used drug propofol, which has significant hemodynamic effects. This study aims to compare the hemodynamic effects of remimazolam with propofol during general anesthesia.

Evidence acquisition: A systematic search was conducted in Embase, Web of Science, Cochrane Library, Scopus, and PubMed databases on 13/02/2023, following the recommendations of Cochrane Handbook and the PRISMA statement. The measure of association used was Risk Ratio (RR) or standardized mean difference, with 95% confidence intervals (CI) and 95% Prediction intervals (PI). An additional search was conducted on 04/09/2023. A Trial Sequential Analysis and a GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence table were conducted based on the editor's recommendation.

Evidence synthesis: After applying eligibility criteria and removing duplicates, 16 randomized clinical trials comprising 1951 patients were included in the meta-analysis. Significant associations favoring remimazolam over propofol were observed in the following aspects: intraoperative hypotension events (RR=0.47; 95% CI=0.41 to 0.54; 95% PI=0.40 to 0.55); frequency of vasoactive drug administration (RR=0.54; 95% CI=0.46 to 0.64; 95% PI=0.41 to 0.74); intraoperative bradycardia (RR=0.39; 95% CI=0.27 to 0.57; 95% PI=0.26 to 0.66); mean arterial pressure at induction (MD=7.77; 95% CI=6.00 to 9.55; 95% PI=4.39 to 11.15); heart rate at induction (MD=6.40; 95% CI=4.07 to 8.73; 95% PI=0.33 to 12.48); and heart rate at intubation (MD=6.06; 95% CI=2.33 to 9.78; 95% PI=-5.59 to 17.71).

Conclusions: This study provides evidence that remimazolam induces fewer cardiorespiratory depressant effects and has a more favorable side effect profile compared to propofol during general anaesthesia.

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来源期刊
Minerva anestesiologica
Minerva anestesiologica 医学-麻醉学
CiteScore
4.50
自引率
21.90%
发文量
367
审稿时长
4-8 weeks
期刊介绍: Minerva Anestesiologica is the journal of the Italian National Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care. Minerva Anestesiologica publishes scientific papers on Anesthesiology, Intensive care, Analgesia, Perioperative Medicine and related fields. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors.
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