重新考虑腰部手术中的麻醉:一个雨审查的醒来与全身麻醉
Favour C Ononogbu-Uche1, Carl Tchoumi2, Nolan M Stubbs3
1Department of Neurosurgery, Duke University, Durham, NC 27710, USA.
脊椎麻醉 (SA) 在腰椎手术中可能比全身麻醉 (GA) 有优势,包括更短的手术时间和住院时间. 然而,需要更多的研究来证实这些好处,并确定最佳的患者选择.
科学领域:
- 麻醉学 麻醉学
- 神经外科 神经外科
- 基于证据的医学基于证据的医学.
背景情况:
- 腰椎退行性疾病需要许多脊柱手术.
- 麻醉选择会影响手术结果,包括恢复和风险.
- 使用脊髓麻醉 (SA) 的清醒手术正在作为全身麻醉 (GA) 的替代品引起人们的兴趣.
研究的目的:
- 综合了对腰椎手术SA和GA进行比较的元分析的发现.
- 评估麻醉选择对术后结果的影响.
- 评估现有证据的质量和可信度.
主要方法:
- 总体审查方法.
- 在主要数据库 (PubMed,Embase,Web of Science) 进行系统的文献搜索.
- 综合使用R包的元分析数据和使用AMSTAR2和Ioannidis标准的可信度评估.
主要成果:
- SA与更短的手术时间,更短的停留时间和更少的血液损失有关 (III/IV级可信度).
- 术后恶心/吐的几率较低,并减少了对止痛药的需求,具有SA (IV级可信度).
- 血液动力学事件,术后疼痛或整体并发症率没有显著差异.
结论:
- SA显示腰椎手术的潜在益处,包括效率和恢复指标.
- 证据质量各不相同,有些结果具有相当大的异质性,可信度低至中等.
- 需要进一步进行高质量的研究来完善效果大小并指导患者/程序选择.
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