七氟醚在兒科麻醉維持中的系統評價_《中國循證醫學雜志》

作者：

孫捷豪 , 韓寧 ,  吳秀英

中國醫科大學盛京醫院麻醉科（沈陽 110004）;

關鍵詞：

七氟醚兒科麻醉維持系統評價

DOI：

10.7507/1672-2531.20080218

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目的　系統評價七氟醚在兒科麻醉維持中的效果及其并發癥。
方法　電子檢索PubMed、EBSCO、OVID、Springer、外文生物醫學期刊全文數據庫和CBMdisc、CNKI，檢索文獻起止時間均從建庫至2008年4月，檢索納入文獻的參考文獻，納入七氟醚用于兒科麻醉維持的所有隨機對照試驗，按Cochrane系統評價方法評價納入研究的方法學質量，并提取有效數據，用RevMan 4.2.10軟件進行Meta分析。
結果　共納入20個隨機對照試驗，包括1 592例患兒。Meta 分析結果顯示：① 蘇醒時間：七氟醚與丙泊酚相似［WMD=0.22，95%CI（–2.86，3.30）］，比地氟醚慢［WMD=5.01，95%CI（2.87，7.16）］，比異氟醚快［WMD=-0.55，95%CI（–0.74，–0.37）］。② 術后出蘇醒室時間：七氟醚與丙泊酚［WMD= –4.39，95%CI（–10.02，1.25）］、地氟醚［WMD=1.13，95%CI（–3.25，5.51）］、異氟醚［WMD= –8.17，95%CI（–17.94，1.60）］相比，差異均無統計學意義；③ 術后躁動：七氟醚明顯比丙泊酚高［RR=5.53，95%CI（2.99，10.21）］，比地氟醚低［RR=0.55，95%CI（0.35，0.88）］，與異氟醚差異無統計學意義［RR=1.24，95%CI（0.85，1.80）］；④ 術后惡心嘔吐（PONV）：七氟醚比丙泊酚發生率高［RR=2.17，95%CI（1.21，3.90）］，與地氟醚相比，差異無統計學意義［RR=0.88，95%CI（0.61，1.25）］；⑤ 眼心反射：七氟醚比丙泊酚發生率低［RD= –0.42，95%CI（–0.56，–0.27）］，與地氟醚相比，差異無統計學意義［RR=0.93，95%CI（0.61，1.41）］。
結論　現有有限的資料證明：在早期蘇醒時間上，七氟醚與丙泊酚相似，比地氟醚慢，而比異氟醚快；在術后恢復時間上，七氟醚與其它三者間無差異；七氟醚的術后躁動明顯比丙泊酚多，但與吸入麻醉藥相比，七氟醚有優勢；在術后惡心嘔吐上，吸入麻醉藥要比靜脈麻醉藥發生率高；七氟醚眼心反射要明顯小于丙泊酚。

引用本文： 孫捷豪,韓寧,吳秀英. 七氟醚在兒科麻醉維持中的系統評價. 中國循證醫學雜志, 2008, 08(11): 988-996. doi: 10.7507/1672-2531.20080218 復制

1.	Elliott RA, Payne K, Moore JK, et al. Clinical and economic choices in anaesthesia for day surgery: a prospective randomized controlled trial. Anaesthesia, 2003, 58(5): 412-421.
2.	鄧曉明, 唐耿志, 羅茂萍, 等. 小兒七氟醚和異氟醚快速吸入誘導的比較. 現代外科, 1999, 5(2): 8-10.
3.	Sale SM, Read JA, Stoddart PA, et al. Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy. Br J Anaesth, 2006, (6): 774-778.
4.	Picard V, Dumont L, Pellegrint M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44: 307-310.
5.	Ira TC, Juliac F, Raafat S, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13: 63-67.
6.	Lopéz GM, Brimacombe J, Clar B. Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children. Paediatr Anaesth, 1999, 9(6): 485-490.
7.	Shin N, Hajime F, Hiromune Y. Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in schoolaged children: a comparison with sevofl urane. J Anesth, 2007, 21: 19-23.
8.	杜懷清, 張鴻, 李萍, 等. 七氟烷、笑氣復合七氟烷以及靜脈丙泊酚用于小兒斜視手術麻醉的特點比較. 中國斜視與小兒眼科雜志, 2007, 15: 13-17.
9.	Jacob S, Rolf H, Martin K, et al. Hemodynamic differences between propofol–remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants. Pediatr Anesth, 2007, 17: 32-37.
10.	Yavuz G, Levent K, Kamil T. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth, 1999, 9: 495-499.
11.	Simurina T, Mikulandra S, Mraovi? B, et al. The effect of propofol and fentanyl as compared with sevoflurane on postoperative vomiting in children after adenotonsillectomy. Coll Antropol, 2006, 30(2): 343-247.
12.	Mayer J, Boldt J, Kerstin D, et al. Reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Pedtatr Anesth, 2006, 102: 400-404.
13.	Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
14.	曹建平, 徐葭, 繆小勇, 等. 低流量地氟醚和七氟醚在小兒麻醉的臨床應用. 東南國防醫藥, 2007, 9: 188-189.
15.	Valley RD, Freid EB, Bailey AG, et al. Tracheal extubation of deeply anesthetized pediatric patients: A comparison of desflurane and sevoflurane. Anesth Analg, 2003, 96: 1320-1324.
16.	Welborn LG, Hannallah RS, Norden JM, et al. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg, 1996, 83: 917-920.
17.	Cohen IT, Juliac F, Raafat S, et al. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg, 2002, 94: 1178-1181.
18.	Demirbilek S, Togal T, Cicek M, et al. Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia. Eur J Anaesthesiol, 2004, 21: 538-542.
19.	Isik Y, Goksu S, Kocoglu H, et al. Low flow desflurane and sevoflurane anaesthesia in children. Eur J Anaesthesiol, 2006, 23: 60-64.
20.	Oh AY, Yun MJ, Kim HJ, et al. Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery. Br J Anaesth, 2007, 99(2): 262-265.
21.	Meyer RR, Peter M, Christian W, et al. Isoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children–a randomized controlled study. Pediatr Anesth, 2007, 17: 56-60.
22.	Bortone L, Ingelmo P, Grossi S, et al. Emergence agitation in preschool children: double-blind, randomized, controlled trial comparing sevoflurane and isoflurane anesthesia. Pediatr Anesth, 2006, 16: 1138-1143.
23.	Delvi MB, Samarkandi A, Zahrani T, et al. Recovery profile for magnetic resonance imaging in pediatric daycase--sevoflurane vs. isoflurane. Middle East J Anesthesiol, 2007, 19(1): 205-211.
24.	Fisher. Surrogate end points. Anaesthesiology, 1994, 81: 795-796.
25.	Brett CM, Zwass MS, France NK. Eyes, ears, nose, throat, and dental surgery. Gregory GA, Pediatric Anesthesia, 3rd edn, New York, Churchill Livingstone, 1994: 657-698.

1. Elliott RA, Payne K, Moore JK, et al. Clinical and economic choices in anaesthesia for day surgery: a prospective randomized controlled trial. Anaesthesia, 2003, 58(5): 412-421.
2. 鄧曉明, 唐耿志, 羅茂萍, 等. 小兒七氟醚和異氟醚快速吸入誘導的比較. 現代外科, 1999, 5(2): 8-10.
3. Sale SM, Read JA, Stoddart PA, et al. Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy. Br J Anaesth, 2006, (6): 774-778.
4. Picard V, Dumont L, Pellegrint M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44: 307-310.
5. Ira TC, Juliac F, Raafat S, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13: 63-67.
6. Lopéz GM, Brimacombe J, Clar B. Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children. Paediatr Anaesth, 1999, 9(6): 485-490.
7. Shin N, Hajime F, Hiromune Y. Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in schoolaged children: a comparison with sevofl urane. J Anesth, 2007, 21: 19-23.
8. 杜懷清, 張鴻, 李萍, 等. 七氟烷、笑氣復合七氟烷以及靜脈丙泊酚用于小兒斜視手術麻醉的特點比較. 中國斜視與小兒眼科雜志, 2007, 15: 13-17.
9. Jacob S, Rolf H, Martin K, et al. Hemodynamic differences between propofol–remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants. Pediatr Anesth, 2007, 17: 32-37.
10. Yavuz G, Levent K, Kamil T. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth, 1999, 9: 495-499.
11. Simurina T, Mikulandra S, Mraovi? B, et al. The effect of propofol and fentanyl as compared with sevoflurane on postoperative vomiting in children after adenotonsillectomy. Coll Antropol, 2006, 30(2): 343-247.
12. Mayer J, Boldt J, Kerstin D, et al. Reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Pedtatr Anesth, 2006, 102: 400-404.
13. Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
14. 曹建平, 徐葭, 繆小勇, 等. 低流量地氟醚和七氟醚在小兒麻醉的臨床應用. 東南國防醫藥, 2007, 9: 188-189.
15. Valley RD, Freid EB, Bailey AG, et al. Tracheal extubation of deeply anesthetized pediatric patients: A comparison of desflurane and sevoflurane. Anesth Analg, 2003, 96: 1320-1324.
16. Welborn LG, Hannallah RS, Norden JM, et al. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg, 1996, 83: 917-920.
17. Cohen IT, Juliac F, Raafat S, et al. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg, 2002, 94: 1178-1181.
18. Demirbilek S, Togal T, Cicek M, et al. Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia. Eur J Anaesthesiol, 2004, 21: 538-542.
19. Isik Y, Goksu S, Kocoglu H, et al. Low flow desflurane and sevoflurane anaesthesia in children. Eur J Anaesthesiol, 2006, 23: 60-64.
20. Oh AY, Yun MJ, Kim HJ, et al. Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery. Br J Anaesth, 2007, 99(2): 262-265.
21. Meyer RR, Peter M, Christian W, et al. Isoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children–a randomized controlled study. Pediatr Anesth, 2007, 17: 56-60.
22. Bortone L, Ingelmo P, Grossi S, et al. Emergence agitation in preschool children: double-blind, randomized, controlled trial comparing sevoflurane and isoflurane anesthesia. Pediatr Anesth, 2006, 16: 1138-1143.
23. Delvi MB, Samarkandi A, Zahrani T, et al. Recovery profile for magnetic resonance imaging in pediatric daycase--sevoflurane vs. isoflurane. Middle East J Anesthesiol, 2007, 19(1): 205-211.
24. Fisher. Surrogate end points. Anaesthesiology, 1994, 81: 795-796.
25. Brett CM, Zwass MS, France NK. Eyes, ears, nose, throat, and dental surgery. Gregory GA, Pediatric Anesthesia, 3rd edn, New York, Churchill Livingstone, 1994: 657-698.

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七氟醚在兒科麻醉維持中的系統評價

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《中國循證醫學雜志》

七氟醚在兒科麻醉維持中的系統評價

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