局麻与全麻经皮内镜腰椎间盘切除术的荟萃分析△

A meta-analysis on percutaneous endoscopic lumbar discectomy under local versus general anesthesia

摘要:

［目的］ 比较局麻与全麻经皮内镜腰椎间盘切除术 （percutaneous endoscopic lumbar discectomy, PELD） 的临床疗效。 ［方法］ 计算机检索 2022 年 3 月以前中国知网、万方、维普、EMBASE、PubMed、CBM、The Cochrane library 数据库收录的文献，搜集有关局麻与全麻下 PELD 的临床研究，采用 Stata/SE 12.0 软件对结局指标进行荟萃分析。［结果］共纳入 9 个研究，包含 796 例患者，其中局麻组 388 例，全麻组 408 例。荟萃分析结果显示：局麻组住院时间（WMD=-1.39，95%CI：-2.72~0.06， P<0.05）、治疗费用 （WMD=-5 278.27，95%CI：-7 668.84~-2 887.70，P<0.05） 和术后并发症的发生率 （RR=0.30，95%CI： 0.11~0.85，P<0.05）均显著优于全麻组（P<0.05）；两种麻醉方式手术时间、术后 VAS 评分、术后 Oswestry 功能障碍指数的差异均无统计学意义（P>0.05）。［结论］局麻下 PELD 住院时间、治疗费用和术后并发症的发生率明显低于全麻，但在安全性方面未见明显劣势。

Abstract:

[Objective] To compare the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) under local anesthe- sia (LA) versus general anesthesia (GA) . [Methods] Literatures published before March 2022 regarding to clinical comparison of PELD un- der LA versus GA were searched from CNKI, Wanfang, VIP, EMBASE, PubMed, CBM and the Cochrane Library. A meta-analysis of out- come measures was performed using Stata/SE 12.0 software. [Results] A total of 9 studies were included into this study, involving 796 pa- tients, including 388 patients in the LA group and 408 patients in the GA group. As results of the meta-analysis, the LA group proved sig- nificantly superior to the GA group in terms of hospital stay (WMD=-1.39, 95%CI: -2.72~0.06, P＜0.05) , hospitalization cost (WMD=-5 278.27, 95%CI: -7 668.84~-2 887.70, P＜0.05) , and incidence of postoperative complications (RR=0.30, 95%CI: 0.11-0.85, P＜0.05) . However, there were no significant differences between the two groups in terms of operation time, postoperative VAS score, and postopera- tive Oswestry disability index (P＞0.05) . [Conclusion] The PELD under local anesthesia is significantly better than that under general an- esthesia in terms of hospital stay, treatment cost and incidence of postoperative complications, and the former has no obvious disadvantage in terms of safety.