【原】【罌粟摘要】比較瑞馬唑侖與丙泊酚用于全靜脈麻醉后患者的術后主觀恢復質量：一項薈萃分析

罌粟花anesthGH 2024-09-23 發(fā)布于貴州

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比較瑞馬唑侖與丙泊酚用于全靜脈麻醉后患者的術后主觀恢復質量：一項薈萃分析

貴州醫(yī)科大學麻醉與心臟電生理課題組

翻譯：柏雪編輯：王婷婷審校：曹瑩

背景: 瑞馬唑侖是一種新型超短效苯二氮卓類藥物，最近作為丙泊酚的替代品被引入全身麻醉。雖然這兩種藥物在安全性和有效性方面已進行了比較，但它們對術后恢復質量(QoR)的相對影響尚不清楚。因此，本薈萃分析旨在比較瑞馬唑侖和丙泊酚對全身麻醉手術患者主觀QoR的影響。

方法：檢索Medline、Embase、Google Scholar和Cochrane中央對照試驗注冊庫(Central Register of Controlled Trials)，搜索從成立到2024年5月28日的隨機對照試驗，比較瑞馬唑侖和丙泊酚在術后QoR方面的差異。采用Cochrane偏倚風險工具(RoB 2)評估研究質量。采用隨機效應薈萃分析評估術后第1天(POD) QoR評分(主要結局)、第2-3天QoR評分、QoR維度、失去意識時間、其他恢復特征和補救性鎮(zhèn)痛需求。

結果：這項薈萃分析納入了2022年至2024年間發(fā)表的13項研究，涉及1418名患者。QoR評估使用QoR 15問卷（10項研究）或QoR 40問卷（3項研究）。結果顯示，瑞馬唑侖與丙泊酚在POD 1和POD 2-3的QoR評分(標準化平均差為0.02,95%可信區(qū)間[CI]: - 0.20, 0.23, P = 0.88, I² = 73%)無顯著差異。此外，在QoR維度、麻醉后恢復室(PACU)停留時間、拔管時間以及躁動和術后惡心嘔吐的風險方面沒有觀察到顯著差異。給予瑞馬唑侖的患者麻醉誘導較慢(平均差值[MD]: 32.27 s)，但比給予丙泊酚的患者意識恢復更快(MD:?1.60 min)。此外，使用瑞馬唑侖后在PACU的鎮(zhèn)痛需求較低（風險比：0.62，95% CI：0.43, 0.89，P = 0.009，I2 = 0%），但在病房中無此差異。

結論：瑞馬唑侖與丙泊酚QoR相似，在意識恢復和術后鎮(zhèn)痛方面具有優(yōu)勢，是全身麻醉中丙泊酚的理想替代藥。

原始文獻來源：Kuo?Chuan Hung, Wei?Ting Wang, Wei?Cheng Liu, et al. Comparing subjective quality of recovery between remimazolam- and propofol-based total intravenous anesthesia for surgical procedures: a meta-analysis. Systematic Reviews (2024) 13:235

Comparing subjective quality of recovery between remimazolam- and propofol-based total intravenous anesthesia for surgical procedures: a meta-analysis

Background Remimazolam is a novel ultrashortacting benzodiazepine that has been recently introduced as an alternative to propofol for general anesthesia. While both agents have been compared in terms of safety and efficacy, their relative effects on postoperative quality of recovery (QoR) remain unclear. Therefore, this meta analysis aimed to compare the effects of remimazolam and propofol on subjective QoR in surgical patients who underwent general anesthesia.

Methods Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched from inception to May 28, 2024 to identify randomized controlled trials comparing remimazolam and propofol in terms of postoperative QoR. The Cochrane riskofbias tool (RoB 2) was used to assess study quality. QoR score on postoperative day (POD) 1 (primary outcome), QoR scores on PODs 2–3, QoR dimensions, time to loss of con sciousness, other recovery characteristics, and rescue analgesia requirement were evaluated using randomeffects metaanalyses.

Results This metaanalysis included 13 studies published between 2022 and 2024 involving 1,418 patients. QoR was evaluated using either the QoR15 (10 studies) or QoR40 (3 studies) questionnaire. The pooled results indicated no significant difference in the QoR scores on POD 1 (standardized mean difference: 0.02, 95% confidence interval [CI]: ? 0.20, 0.23, P = 0.88, I² = 73%) and PODs 2–3 between remimazolam and propofol. Furthermore, no significant differences were observed in QoR dimensions, length of postanesthesia care unit (PACU) stay, and time to extubation as well as in the risks of agitation and postoperative nausea and vomiting. Patients administered remimazolam exhibited slower anesthetic induction (mean difference (MD): 32.27 s) but faster recovery of consciousness (MD: ? 1.60 min) than those administered propofol. Moreover, remimazolam was associated with a lower risk of rescue analgesia requirement in the PACU (risk ratio: 0.62, 95% CI: 0.43, 0.89, P = 0.009, I² = 0%) but not in the ward.

Conclusion Remimazolam is a potential alternative to propofol for general anesthesia as it offers similar QoR to the latter and has advantages in terms of consciousness recovery and immediate postoperative analgesia requirement.

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