小儿七氟醚麻醉的诱导_七氟醚与氯胺酮在小儿麻醉维持中的荟萃分析

　　[摘要] 目的 系统评价七氟醚和氯胺酮在小儿麻醉维持中的效果及其并发症，为其临床决策提供依据。 方法 以七氟醚或氯胺酮、小儿麻醉维持为检索词，检索Pubmed、中国知网和维普等数据库，文献起止时间均从建库至2011年12月，纳入所有采用七氟醚吸入或氯胺酮静脉维持小儿麻醉的研究文献，用RevMan 5.1.1软件进行Meta分析。 结果 共纳入17个随机对照试验，3 771例患儿。Meta 分析结果示，①呼吸道分泌物：七氟醚麻醉口腔分泌物明显少于氯胺酮[RR = 0.03，95%CI（0.01，0.09）]；②术中躯体运动：氯胺酮全麻术中体动高于七氟醚全麻[RR = 0.06，95%CI（0.03，0.12）]；③术后睁眼或体动时间：七氟醚的苏醒时间明显短于氯胺酮[WMD = -29.84，95%CI（-36.61，-23.07）]；④出手术室或PACU时间：七氟醚的出室或PACU的时间少于氯胺酮[WMD = -21.41，95%CI（-29.99，-12.84）]；⑤术后躁动：七氟醚术后躁动发生率显著高于氯胺酮[RR = 0.07，95%CI（0.04，0.11）]；⑥术后呕吐：两者之间差异无统计学意义[RR = 0.75，95%CI（0.61，0.93）]。 结论 小儿氯胺酮麻醉后分泌物明显多于七氟醚，术中七氟醚维持较少出现体动，七氟醚麻醉苏醒更快，但七氟醚麻醉术后躁动明显高于氯胺酮。
　　[关键词] 七氟醚；氯胺酮；小儿麻醉维持；系统评价
　　[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2012）08（b）-0081-04
　　Meta-analysis of Sevoflurane and Ketamine in pediatric anesthesia maintenance
　　ZHOU Bin XIA Zhongyuan XUE Rui WU Yang
　　Department of Anesthesiology, the People′s Hospital of Wuhan University, Hubei Province, Wuhan 430060, China
　　[Abstract] Objective To systemically review effect and complication of Sevoflurane and Ketamine in pediatric anesthesia maintenance, and provide evidence for clinical decision. Methods All related literatures on Sevoflurane inhalation or Ketamine intravenous maintenance anesthesia in pediatrics, taking Sevoflurane and pediatric anesthesia maintenance or Ketamine and pediatric anesthesia maintenance as search terms in database of Pubmed, Chinese national knowledge infrastructure (CNKI), and VIP from establishment of its own database to December 2011, were Meta-analyzed by RevMan 5.1.1. Results 17 randomized controlled trial and 3 771 cases of child patients were included. Results of Meta-analysis were as follows. ①Amount of oral secretion by Sevoflurane anesthesia was less than that of Ketamine [RR = 0.03, 95%CI (0.01, 0.09)]. ②Frequency of intraoperative body movement by Ketamine general anesthesia was higher than that by Sevoflurane general anesthesia [RR = 0.06, 95%CI (0.03, 0.12)]. ③Time to open eyes or move body anesthetized by Sevoflurane after surgery was shorter than that of Ketamine [WMD = -29.84, 95%CI (-36.61, -23.07)]. ④Out of the operating room or post anesthesia care unit time in Sevoflurane was less than that of Ketamine [WMD = -21.41, 95%CI (-29.99, -12.84)]. ⑤Incidence of postoperative restlessness in Sevoflurane was higher than that of Ketamine [RR = 0.07, 95%CI (0.04, 0.11)]. ⑥There was no statistical difference in vomiting condition after surgery between the two anesthetics [RR = 0.75，95%CI（0.61，0.93）]. Conclusion Compared with Ketamine, available literatures indicate that less respiratory secretions after Sevoflurane anesthesia, less body movement in Sevoflurane maintenance, and faster postoperative recovery by Sevoflurane general anesthesia, but with a higher incidence of postoperative restlessness.