麻醉方式对髋关节置换术后血栓形成影响的Meta分析
[摘要]目的 系统评价不同麻醉方式对髋关节置换术后血栓形成的影响。方法 计算机检索1980年1月~2018年3月PubMed、Embase、Cochrane Library、中国知网、万方、中国生物医学数据库,检索不同麻醉方式对髋关节置换术后血栓形成影响的随机对照试验(RCT),筛选文献,进行质量评价、数据提取及统计分析。结果 共搜索到245篇文献,最终纳入22篇符合纳入标准的RCT。Meta分析显示,椎管内麻醉与全身麻醉相比,前者可以使髋关节置换术后血栓形成的发生率明显下降[OR=0.31,95%CI(0.24~0.40)],差异有统计学意义(P<0.05)。亚组分析显示,硬膜外麻醉、蛛网膜下麻醉及腰硬联合麻醉三种椎管内麻醉方式均可降低髋关节置换术后血栓的形成[OR=0.26,95%CI(0.20~0.35)],差异有统计学意义(P<0.05);在未预防应用抗凝剂的条件下,与全身麻醉相比,椎管内麻醉可使髋关节置换术后肺栓塞(PE)的发生率明显下降[OR=0.23,95%CI(0.10~0.49)],差异有统计学意义(P<0.05)。结论 与全身麻醉相比,椎管內麻醉可以降低髋关节置换术后血栓形成的发生率,并且与椎管内麻醉方式的选择无明显相关性。因此,对于血栓形成高危人群的髋关节手术,建议进行椎管内麻醉,以减少术后血栓形成和PE的发生。
[关键词]椎管内麻醉;全身麻醉;髋关节置换术;血栓形成
[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721(2019)5(a)-0009-05
[Abstract] Objective To systematically evaluate the influence of different anesthetia methods on the incidence of thrombosis after hip arthroplasty. Methods PubMed, Embase, Cochrane Library, CNKI, Wanfang and Sinomed database from January 1980 to March 2018 were retrieved by computer. Randomized controlled trials (RCTs) were performed to search for the influence of different anesthesia methods on thrombosis after hip arthroplasty. The literature was screened for quality evaluation, data extraction and statistical analysis. Results A total of 245 articles were searched and 22 RCTs meeting the criteria were finally included. Meta analysis showed that compared with general anesthesia, neuraxial anesthesia could red...
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