局部麻醉与镇静和全身麻醉治疗慢性硬膜下血肿的比较：一项系统回顾和meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：严旭            编辑：王波          审校：曹莹


背景

手术是慢性硬膜下血肿的主要治疗方法，麻醉会显著影响手术结果。之前的系统回顾将319名患者的全身麻醉与局部麻醉进行了比较。我们的研究以这项研究为基础，分析了4,367个案例，以提供最新和严格的证据。

方法


我们系统地搜索了五个电子数据库：PubMed、Cochrane Library、Scopus、Ovid Medline和Web of Science，以确定符合条件的比较研究。在2023年9月之前发表的所有研究都包含在我们的分析中。我们使用Review Manager软件比较了两组之间的六个主要结果。

结果

【罂粟摘要】局部麻醉与镇静和全身麻醉治疗慢性硬膜下血肿的比较：一项系统回顾和meta分析

meta分析包括18项研究，共涉及4,367名参与者。分析显示，这两种技术在“复发率”（OR = 0.95，95% CI [0.78至 1.15]，P = 0.59）、“死亡率”（OR = 1.02，95% CI [0.55至1.88]，P = 0.96）和“重操作率”（OR = 0.95，95% CI [0.5至1.79]，P = 0.87）方面没有显著差异。局部麻醉表现出优越性，与全身麻醉相比，“并发症发生率”较低，因为后者出现并发症的几率几乎是2.4倍（OR = 2.4，95% CI [1.81至3.17]，P < 0.00001）。此外，局部麻醉与较短的“住院时间”（SMD = 1.19，95% CI [1.06至 1.32]，P < 0.00001）和“手术持续时间”缩短（SMD = 0.94，95% CI [0.67至1.2]，P < 0.00001）有关。


结论


      局部麻醉下慢性硬膜下血肿手术导致并发症减少，住院时间缩短，手术时间缩短。

原始文献来源：Mariam Ahmed Abdelhady ， Ahmed Aljabali， Mohammad Al‐Jafari4，et，al.Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis [J].Neurosurg Rev, 2024 Apr 16;47(1):162. doi: 10.1007/s10143-024-02420-1.

Local anesthesia with sedation and general anesthesia  for the treatment of chronic subdural hematoma: a systematic review  and meta‑analysis

Background Surgery is the primary treatment for chronic subdural hematoma, and anesthesia significantly impacts the surgery’s outcomes. A previous systematic review compared general anesthesia to local anesthesia in 319 patients. Our study  builds upon this research, analyzing 4,367 cases to provide updated and rigorous evidence. 

Methods We systematically searched five electronic databases: PubMed, Cochrane Library, Scopus, Ovid Medline, and  Web of Science, to identify eligible comparative studies. All studies published until September 2023 were included in our  analysis. We compared six primary outcomes between the two groups using Review Manager Software. 

Results Eighteen studies involving a total of 4,367 participants were included in the meta-analysis. The analysis revealed no  significant difference between the two techniques in terms of ‘recurrence rate’ (OR=0.95, 95% CI [0.78 to 1.15], P=0.59),  ‘mortality rate’ (OR=1.02, 95% CI [0.55 to 1.88], P=0.96), and ‘reoperation rate’ (OR=0.95, 95% CI [0.5 to 1.79], P=0.87).  Local anesthesia demonstrated superiority with a lower ‘complications rate’ than general anesthesia, as the latter had almost 2.4  times higher odds of experiencing complications (OR=2.4, 95% CI [1.81 to 3.17], P<0.00001). Additionally, local anesthesia  was associated with a shorter ‘length of hospital stay’ (SMD=1.19, 95% CI [1.06 to 1.32], P<0.00001) and a reduced ‘duration  of surgery’ (SMD=0.94, 95% CI [0.67 to 1.2], P<0.00001). 

Conclusion Surgery for chronic subdural hematoma under local anesthesia results in fewer complications, a shorter length  of hospital stay, and a shorter duration of the operation.

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