依托咪酯-芬太尼类药物在老年胃镜检查应用的Meta分析*

摘要：
Abstract: Objective?To make a systematical review of the safety and efficacy of Etomidate plus Fentanyl-class drugs and Propofol plus Fentanyl-class drugs in older patients undergoing gastroscopy. ?Methods?We searched the Cochrane library, PubMed, Embase, China Biology Medicine (CBM), CNKI, VIP, Wanfang Database for all randomized controlled trials (RCTs) about the efficacy of Etomidate plus Fentanyl-class drugs(Fentanyl, Sufentanil, remifentanil) in older patients undergoing gastroscopy. The quality of the studies was evaluated by the method recommended by the Jadad scale. Meta-analysis was conducted using the Cochrane Collaboration’s RevMan 5.3 software.?Results?11 RCTs involving 1 535 patients were analyzed. Meta-analysis showed that patients in the Etomidate group had a lower heart rate [Weighted Mean Difference (WMD)=2.25, 95%CI(0.93, 3.56), P = 0.001] and mean arterial pressure [WMD = 9.09, 95%CI (7.60, 10.57), P = 0.000] fluctuation than whose of the Propofol group. The hypoxemia occurrence [OR=0.46, 95% CI (0.32, 0.65), P = 0.000] in Etomidate group is also lower than which of the Propofol group. For side effects aspects, the risk of apnea[OR=0.26, 95%CI(0.15, 0.48), P = 0.000] and injection pain [OR= 0.02, 95%CI (0.01, 0.05), P = 0.000] in the Etomidate group is much lower than the Propofol group ,while the myoclonus [OR=8.14, 95%CI (4.18, 15.87), P = 0.000], nausea and vomiting [OR=3.44, 95%CI (2.03, 5.84), P = 0.000] were more incidental than the Propofol group.?Conclusion?Etomidate plus Fentanyl-class drugs can effectively maintain circulatory system for the old undergoing painless gastroscopy, demonstrated to be a safe and valid anesthesia method.