【原】【罂粟摘要】针刺-药物联合麻醉在甲状腺手术中的应用:系统综述和荟萃分析

针刺-药物联合麻醉在甲状腺手术中的应用:系统综述和荟萃分析

贵州医科大学  麻醉与心脏电生理课题组

翻译：柏雪   编辑：柏雪    审校：曹莹

背景:针药联合麻醉(CAMA)在甲状腺手术中应用广泛。我们进行了系统回顾和荟萃分析来评估CAMA的有效性和安全性。

方法:检索中国知网(CNKI)、维普数据库、万方数据库、PubMed、EMBASE、Cochrane图书馆等相关文献。文献发表期限为2020年4月18日前，不限发表语言、地区、发表年份。纳入标准包括针刺联合颈丛麻醉的随机对照试验(RCT)。我们使用RevMan5.3软件进行数据分析。若经卡方检验无显著异质性(P>0.10,I²<50%)，则采用固定效应模型计算风险比(RR)和均差。否则，采用随机效应模型。

结果:共纳入18项随机对照试验，涉及1211例患者。经皮穴位电刺激(TEAS)+颈丛阻滞麻醉(CPBA)组和电针(EA)+CPBA组的麻醉显著率(ASR)均显著高于CPBA组(TEAS+CPBA组: P<0.001; EA+CPBA组: p<0.001)。TEAS+CPBA组和EA + CPBA组术中心率(HR)和平均动脉压(MAP)的综合效应值均显著低于对照组(HR: P=0.05，p<0.001;MAP: P=0.002,p<0.001)。实验组术后不良反应发生率明显低于对照组(RR=0.30, P<0.001)，两组间无差异性(P=0.71,I² = 0%)。

结论:针药联合麻醉可显著提高麻醉显著率，降低术中心率、血压，减少术后不良反应的发生。然而，未来需要更多高质量的研究来进一步验证针刺联合麻醉的有效性和安全性。

原始文献来源：Wei Zhang, Meng Zhang, Yanxun Han, et, al. Combined acupuncture-medicine anesthesia used in thyroid surgery A systematic review and meta-analysis. Medicine (2023) 102:1

英文原文：

Combined acupuncture-medicine anesthesia used in thyroid surgery A systematic review and meta-analysis

Background: Combined acupuncture-medicine anesthesia (CAMA) is extensively used in thyroid surgery in China. We conducted a systematic review and meta-analysis to assess the efficacy and safety of CAMA.

Methods: We searched the China National Knowledge Infrastructure (CNKI), VIP database, WanFang database, PubMed, EMBASE, and the Cochrane Library for relevant literature. The term of literature was published before April 18, 2020, and there were no restrictions on publication language, region, or publication year. The inclusion criteria included a randomized controlled trial (RCT) of acupuncture combined with cervical plexus anesthesia. We used RevMan5.3 software for data analysis. If the chisquare test showed no significant heterogeneity (P > 0.10, I² < 50%), we used the fixed-effect model to calculate risk ratio (RR) and mean difference. Otherwise, the random-effects model was used.

Results: Overall, 18 RCT s involving 1211 patients were included in the study. The anesthesia significant rate (ASR) in the transcutaneous electrical acupoint stimulation (TEAS) plus cervical plexus block anesthesia (CPBA) and electroacupuncture (EA) plus CPBA groups was significantly higher compared with the CPBA group (TEAS+CPBA: P < 0.001; EA+CPBA:p<0.001)The pooled effect values of the intraoperative heart rate (HR) and mean arterial pressure (MAP) were significantly lower in both the TEAS + CPBA and EA + CPBA groups relative to the control group(HR:P=0.05，p<0.001;MAP: P=0.002,p<0.001;respectively). Moreover, the postoperative adverse reaction was markedly lower in the experimental group than in the control group (RR = 0.30, P < 0.001), and there was no heterogeneity between the two groups (P=0.71, I² = 0%).

Conclusion: Combined acupuncture-medicine anesthesia significantly increases the anesthesia significance rate, reduces the intraoperative heart rate, and blood pressure, and reduces the incidence of postoperative adverse reactions. However, more high-quality future studies should be conducted to validate the efficacy and safety of acupuncture combined anesthesia further.

END