圍術期應用血管活性藥物對腹部大手術患者的術後影響：系統回顧與meta分析
翻譯：佟睿 編輯：馮玉蓉 審校：曹瑩
背景：臨床麻醉中血管活性藥物應用普遍，然而其藥物種類、劑量及血流動力學目標卻各不相同。本項研究旨在探討圍術期使用血管活性藥物能否降低接受腹部大手術的成年患者（16歲及以上）的死亡率、發病率和住院時間。
方法：在MEDLINE、EMBASE及Cochrane對照試驗登記中心搜索經同行評審的、涵蓋評估術中血管活性藥物使用情況研究的隨機對照試驗（不限語言及日期）。我們進行了標題、摘要和全文篩選，並對每項結果進行了測量偏倚的評估。運用具有相應95% CI的Mantele-Haenszel隨機效應模型計算二分類結果的風險比率（RR），並採用具有相應95%CI的逆方差隨機效應模型計算連續結果的平均差。
結果：本次分析共納入26項試驗、5561名參與者。在最長的隨訪中，患者術後死亡率無差異；RR：0.84（95% CI: 0.63－1.12; P＝0.23）。幹預組發生一種及以上術後併發症的患者人數明顯降低；RR：0.76（95% CI: 0.66－0.88; P＝0.0002）。幹預組的住院時間減少0.91天。
結論：由於個別研究的質量、樣本量以及環境、幹預措施和結果測量的異質性，本項回顧性研究受到一定限制。圍術期使用血管活性藥物可減少成年患者腹部大手術的術後併發症和住院時間。
原始文獻來源：Deng C, Bellomo R, Myles P. Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery.[J].Br J Anaesth 2020 May; 124(5): 513-524.
Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery
Abstract
Background: The perioperative use of vasoactive drugs is ubiquitous in clinical anaesthesia; yet, the drugs, doses, and haemodynamic targets used are highly variable. Our objectives were to determine whether the perioperative administration of vasoactive drugs reduces mortality, morbidity, and length of stay in adult patients (aged 16 yr or older) undergoing major abdominal surgery.
Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for peer-reviewed RCTs with no language or date restrictions. Studies that assessed the intraoperative use of vasoactive drugs were included. Title, abstract, and full-text screening was performed. Risk of bias for each outcome measure was conducted. We calculated the risk ratio (RR) using the Mantele-Haenszel random-effects model with corresponding 95% confidence interval (CI) for dichotomous outcomes, and mean difference using the inverse variance random-effects model with corresponding 95% CI for continuous outcomes.
Results: Twenty-six studies (5561 participants) were included. There was no difference in mortality at the longest followup with an RR of 0.84 (95% CI: 0.63－1.12; P＝0.23). The intervention significantly reduced the number of patients with one or more postoperative complications; RR: 0.76 (95% CI: 0.66－0.88; P＝0.0002). Hospital length of stay was reduced by 0.91 days in the intervention group.
Conclusions: This review is limited by the quality and sample size of individual studies, and the heterogeneity of the settings, interventions, and outcome measures. Perioperative administration of vasoactive drugs may reduce postoperative complications and hospital length of stay in adult patients having major abdominal surgery. Keywords: cardiovascular agents; goal-directed therapy; haemodynamics; major abdominal surgery; perioperative care; vasoconstrictor agents
貴州醫科大學高鴻教授課題組
【來源：健康界】
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