肝脏手术患者全静脉麻醉与吸入麻醉的比较：系统综述和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology Pub Date : 2025-02-28 DOI:10.1016/j.bjane.2025.844604

Gustavo R.M. Wegner , Bruno F.M. Wegner , Henrik G. Oliveira , Luis A. Costa , Luigi W. Spagnol , Valentine W. Spagnol , Jorge R.M. Carlotto , Eugénio Pagnussatt Neto

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引用次数: 0

摘要

背景：在肝移植或肝切除术中选择吸入麻醉剂和异丙酚维持麻醉的影响尚不确定。方法：根据Cochrane Handbook和PRISMA指南，于2023年9月5日对PubMed、Scopus、Embase、Web of Science和Cochrane Library进行系统检索。结果：纳入15项随机对照试验和5项观察性研究，共1602例患者。统计分析分为三组：肝移植（4项研究）、活体供肝切除术（4项研究）和肝块切除术（12项研究）。根据Pringle手法的表现和药物预处理的使用，进一步细分肝肿块肝切除术组。统计上显著的结果如下。在肝移植受者中，异丙酚麻醉与术后第一天较低的AST水平相关。用异丙酚麻醉的肝供者总输注量和术中尿量较高。与接受药物预处理的患者相比，接受Pringle手法和异丙酚麻醉的肝肿块切除术患者的AST和ALT峰值水平更高。与药物治疗相比，接受Pringle手法和异丙酚麻醉的肝肿物切除术患者在术后第一天和第三天的AST和ALT水平较高，总输注量增加，住院时间缩短。结论：我们的研究结果没有提供足够的证据来指导临床实践。丙泊酚为基础麻醉和吸入麻醉之间的选择应根据个别患者的情况和正在进行的手术的性质而定。注册：普洛斯彼罗ID: CRD42023460715。

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Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis

Background

The impact of choosing between inhalational anesthetics and propofol for maintenance anesthesia in liver transplantation or liver resections remains uncertain.

Methods

A systematic search was conducted on PubMed, Scopus, Embase, Web of Science, and the Cochrane Library on September 5, 2023, adhering to the Cochrane Handbook and PRISMA guidelines.

Results

Fifteen randomized controlled trials and five observational studies, comprising 1,602 patients, were included. The statistical analysis was categorized into three groups: liver transplantation (four studies), living donor hepatectomy (four studies), and liver mass hepatectomy (twelve studies). The liver mass hepatectomy group was further subdivided based on the performance of the Pringle maneuver and the use of pharmacological preconditioning. Statistically significant results are described below. In liver transplant recipients, propofol anesthesia was associated with lower AST levels on the first postoperative day. Hepatic donors anesthetized with propofol had higher total infusion volumes and intraoperative urine output. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher peak AST and ALT levels compared to those who received pharmacological preconditioning. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher AST and ALT levels on both the first and third postoperative days, increased total infusion volumes, and shorter hospital stays, when compared to pharmacological conditioning.

Conclusions

Our findings do not offer sufficient evidence to inform clinical practice. The choice between propofol-based and inhalational anesthesia should be tailored to the individual patient's condition and the nature of the procedure being performed.