Abstract
Objective To investigate the clinical effect and safety of epidural anesthesia combined with general anes-thesia. Methods The literatures were retrieved from the databases of PubMed,Medline,EBSCO,etc.(1987-2012),the quality evaluation and data extraction were performed without language limitation. The English indexing vocabularies were "epidural anesthesia"and"general anesthesia"and the Chinese indexing vocabularies were"硬膜外麻醉"and"全身麻醉". The RevMan 5.0 software was adopted to conduct the evidence-based evaluation analysis. Results A total of 36 trials were included involving 3 162 patients,general anesthesia combined with epidural anesthesia (experimental group) and simple general anesthesia or general anesthesia combined with other analgesic schemes(control group) were respectively adopted. Compared with the control group , epidural anesthesia combined with general anesthesia reduced postoperative 2 h rest pain score[weighted mean difference (WMD)=-0.59,95%CI(-1.04,-0.14)] and cough pain score[WMD=-0.41,95%CI(-0.74,-0.08)],the differences were statistically significant(P<0.05). Compared with the control group,the anesthesia method in the experimental group could reduce the occur-rence of perioperative complications,such as ventricular arrhythmia[relative risk(RR)=0.45,95%CI(0.30,0.67)],supraventricu-lar arrhythmia[RR=0.62,95%CI(0.51,0.75)],respiratory tract infection[RR=0.76,95%CI(0.47,0.93)],conscious disturbance [RR=0.22,95%CI(0.08,0.62)],nausea and vomiting[RR=0.33,95%CI(0.17,0.63)],the differences were statistically signifi-cant(P<0.05);but the occurrence rates of myocardial ischemia,renal failure and stroke,and the mortality had no statistical differ-ence between the two groups(P>0.05). Compared with the control group,the anesthesia method in the experimental group could shorten the time of postoperative mechanical ventilation[WMD=-3.39,95%CI(-5.23,-1.55)],and improved the patient′s satis-faction[WMD=5.14,95%CI(2.75,9.61)],but the hospitalization time showed no statistical difference (P>0.05). The anesthesia method in the experimental group could reduce the dosages of propofol ,ephedrine and inhalation anesthetics. Conclusion Epidural anesthesia combined with general anesthesia can reduce the economic load and improves the prognosis of patients.关键词
麻醉,硬膜外/麻醉,全身/麻醉药/随机对照试验/Meta分析Key words
Anesthesia,epidural/Anesthesia,general/Anesthetics/Randomized controlled trials/Meta-analysis
