术中麻醉交接与患者发病率和死亡率的关系：系统回顾和meta分析
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
术中麻醉交接与患者发病率和死亡率的关系：系统回顾和meta分析
翻译：唐剑 编辑：冯玉蓉 审校：曹莹
背景：手术过程中麻醉病人的交接是很常见的。然而，它与病人预后的关系尚不清楚。本系统回顾旨在评估手术中麻醉交接对患者预后的影响。
方法：纳入所有前瞻性和回顾性临床研究，这些研究专门调查了术中麻醉管理者的转换与患者发病率和死亡率之间的关系。在Medline、Medline in Process、CINAHL和Embase数据库搜索纳入研究的参考文献。由独立评审员对研究的合格性进行评估，分歧通过协商或第三名评审员裁决。对于观察性队列和横断面研究，使用美国国立卫生研究院质量评估工具进行偏倚风险双重评估。鉴于大量异质性，数据以叙事性方式进行总结。对可比较研究的子集使用随机效应模型进行探索性meta分析。
结果：8项研究符合纳入标准。6项研究以患者为分析单位(npatients=605 678)，2项研究以麻醉医生为分析单位(nproviders=307)。7项研究确定了麻醉交接与患者不良预后的关系。而一项研究表明交接可能有利于发现和纠正错误。本次纳入的研究质量良好。对4项研究的meta分析表明，在手术过程中出现麻醉交接时，患者发生不良事件的风险增加了40%(集中风险率=1.40; 95% CI 1.19~ 1.65; P<0.001; I2=98%)。
结论：术中麻醉交接通常会增加手术患者的发病率和死亡率，但在某些情况下可能会提高安全性。未来的研究应该确定影响安全性的具体移交特征。
文献来源：Boet S, Djokhdem H, Leir SA, et al. Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis.Br J Anaesth , 2020;05,25
Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis
Abstract
BACKGROUND: Handover of anaesthesia patient care during surgery is common; however, its association with patient outcome is unclear. This systematic review aimed to assess the impact of anaesthesia handover during surgery on patient outcome.
METHODS: All prospective and retrospective clinical studies specifically investigating the association of intraoperative transfer of anaesthesia care between anaesthesia providers in the operating room with patient morbidity and mortality were included. Searches were conducted from inception to April 24, 2019 in Medline, Medline in Process, CINAHL, and Embase. Reference lists of included studies were searched. Studies were assessed for eligibility and data were extracted by independent reviewers in duplicate with disagreements resolved by consensus or a third reviewer. Risk of bias was assessed in duplicate using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were summarised narratively given substantial heterogeneity. An exploratory meta-analysis was conducted using a random-effects model for a subset of comparable studies.
RESULTS: Eight studies met the inclusion criteria. Six studies focused on patients as the unit of analysis (n=605 678) and two focused on anaesthesia providers as the unit of analysis (n=307). Seven studies identified a relationship between anaesthesia handovers and adverse patient outcomes, whereas one suggested that handover may be beneficial to error detection or rectification. Included studies were of fair or good quality. Meta-analysis of four studies found a 40% increased risk of patients experiencing an adverse event when an anaesthesia handover occurs during the procedure (pooled risk ratio=1.40; 95% confidence interval, 1.19 to 1.65; P<0.001; I=98%).
CONCLUSIONS: Intraoperative anaesthesia handovers generally increase morbidity and mortality for surgical patients but could have the potential to improve safety in certain contexts. Future research should determine the specific handover characteristics that impact safety.
贵州医科大学高鸿教授课题组
麻醉学文献进展分享