肝功能障碍患者异丙酚药代动力参数的Meta分析

    Meta-Analysis of Pharmacokinetics of Propofol in Patients with Hepatosis

    • 摘要: 目的 系统评价肝功能障碍患者异丙酚药代动力学参数,为临床异丙酚个体化用药提供循证医学证据。 方法 计算机检索MEDLINE (1975年至2010年10月)、 OVID、 Springerlink、 中国期刊全文数据库 CNKI(1979年至2010年10月)、重庆维普中文科技期刊全文数据库(1989年至2010年10月)、万方数据资源系统(1996年至2010年10月)、中国生物医学文献数据库(1978年至2010年10月)等,并辅以手工检索。收集所有关于肝功能障碍患者异丙酚药代动力学随机对照试验和非随机对照试验公开发表的文献,使用Cochrane 系统评价方法,评价纳入研究的方法学质量并提取有效数据,用RevMan 4.2软件进行Meta分析。 结果 共检索到153篇英文文献和6篇中文文献,最后纳入6篇非随机对照试验。Meta 分析结果显示: ①肝功能障碍患者与肝功能正常患者相比,异丙酚中央室分布容积和清除率均未见差异有统计学意义。②两者在异丙酚半衰期和速率常数上也未见差异有统计学意义(P>0.05)。③肝功能障碍患者异丙酚稳态分布容积大于对照组,差异有统计学意义加权均数差1.24,95% 可信区间 (0.38,2.10), P=0.005。 结论 肝功能障碍患者除异丙酚稳态分布容积明显高于肝功能正常患者外,其他指标差异无统计学意义,提示肝功能障碍患者异丙酚麻醉时不需降低用量,上述结论尚需进一步验证。

       

      Abstract: Objective To systematically evaluate the propofol pharmacokinetics of patients with hepatosis. Methods Trials were located through electronic searches of the MEDLINE (1975.01-2010.10), OVID, Springerlink, CNKI (1979-2010.10), VIP (1989-2010.10), WANFANG data base (1996-2010.10), CBM (1978-2010.10), to collect the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) about propofol pharmacokinetics, supplemented by manual retrieval. The methodological quality of included trials was assessed, while the data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook. The Revman 4.2 software was used for meta-analysis. Results A total of six trials were included. Meta analysis showed: the central volume distribution and clearance of propofol in patients with hepatosis were similar to those without hepatic dysfunction. There were no differences in half lives of propofol between two groups,and for the constant rates there were no differences, either. Compared with the control group, patients with hepatosis could significantly increase the steady-state distributions WMD=1.24, 95%CI(0.38, 2.10), P=0.005. Conclusions The pharmacokinetics of propofol in patients with hepatosis were similar to the people without hepatic dysfunction. Patients with hepatosis couldn’t reduce propofol dosage. The conclusion still needs high quality clinical control trials to verify.

       

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