单侧与双侧腰麻术后低血压对比：一项系统综述与Meta分析
导语：
腰麻是下腹部及四肢手术中常用的麻醉方式，但术后低血压这一并发症仍令临床医生颇为关注。近日，一项系统综述与Meta分析研究发现，单侧腰麻或许能有效降低低血压的发生率，让我们一起来看看这项研究的结果。
摘要译文
背景：腰麻在下肢及下腹部手术中应用广泛，然而，术后低血压的发生仍是临床上的一个重要问题。单侧腰麻作为一种有望降低这一并发症的方法，其有效性尚存在争议。
目标：本研究旨在通过Meta分析，评估单侧腰麻在降低低血压发生率及其他并发症方面是否优于双侧腰麻。
设计：随机对照试验（RCTs）的系统综述与Meta分析。
数据来源：本研究检索了PUBMED、Embase、Web of Science和Cochrane Central Register of Controlled Trials数据库，时间范围为各数据库建立至2024年3月5日。
纳入标准：比较单侧腰麻与双侧腰麻的随机对照试验（RCTs）被纳入本研究。观察性研究、病例报告、病例系列以及非人类研究被排除。比较了低血压发生率、需要使用升压药物的情况及其他并发症。
结果：共纳入21项试验，涉及1358名患者，这些患者接受了单侧下肢手术或下腹部手术。大部分试验使用了高比重溶液。采用Mantel-Haenszel随机效应模型对二分类终点进行分析，结果以相对风险（RR）及95%置信区间（CI）表示。单侧腰麻组低血压发生率显著低于双侧腰麻组（RR 0.38, 95% CI 0.27 to 0.55; P < 0.001; I2 = 38%）。亚组分析显示，无论剂量、手术部位、局麻药佐剂以及低血压定义如何，单侧腰麻组低血压发生率均显著降低。
结论：单侧腰麻与低血压发生率显著降低相关，尽管低血压的定义、佐剂及手术部位存在差异。这一结果支持在单侧下腹部或下肢手术患者中使用侧卧位腰麻。然而，由于存在较高的偏倚风险和异质性，GRADE证据质量评估为“低”。因此，所有结果均需谨慎对待。
结语：
这项研究为单侧腰麻在降低术后低血压发生率方面的优势提供了证据，但鉴于证据质量较低，临床医生在实际应用中仍需谨慎。未来，期待更多高质量的研究为这一问题提供更为确凿的答案。
原文摘要
Hypotension after unilateral versus bilateral spinal anaesthesia: A Systematic review with meta-analysis
Background: Spinal anaesthesia is frequently used in surgical procedures involving the lower abdomen and extremities, however, the occurrence of hypotension remains a common and clinically important adverse effect. Unilateral spinal anaesthesia seems to be a promising approach to minimise this complication but the effectiveness of this remains controversial.
Objective: A meta-analysis was undertaken to evaluate the superiority of unilateral spinal anaesthesia over bilateral spinal anaesthesia with regard to the incidence of hypotension and other complications.
Design: Systematic reviews and meta-analysis of randomised controlled trials (RCTs).
Date sources: PUBMED, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched from their inception to 5 March 2024.
Eligibility criteria: Randomised controlled trials (RCTs) comparing unilateral spinal anaesthesia with bilateral spinal anaesthesia were eligible for inclusion. Observational studies, case reports, case series, and studies not conducted in humans were excluded. The incidence of hypotension, vasopressor requirement, and other complications were compared. Heterogeneity was assessed by subgroup analyses and sensitivity analysis.
Results: Twenty-one trials involving 1358 patients undergoing unilateral lower extremity surgery or lower abdominal surgery were included in the meta-analysis. Hyperbaric solutions were used in most trials. The Mantel-Haenszel random-effect model was used for the analysis of binary endpoints, reported as relative risk (RR) with a 95% confidence interval (CI). The incidence of hypotension was significantly lower in the unilateral spinal anaesthesia group compared with the bilateral spinal anaesthesia (RR 0.38, 95% CI 0.27 to 0.55; P < 0.001; I2 = 38%). Subgroup analysis shows that the occurrence of hypotension was significantly lower in the unilateral subgroup, regardless of dosage, surgical site, adjuvants to the local anaesthetics, and different definitions of hypotension.
Conclusions: Unilateral spinal anaesthesia is associated with a significant reduction in the occurrence of hypotension, despite variations in the definition of hypotension, adjuvants, and site of surgery. These results favour the use of lateral spinal anaesthesia in patients undergoing unilateral lower abdominal or lower limb surgery. However, the GRADE assessment of the quality of evidence was 'low' due to the high risk of bias and heterogeneity. All the results should be treated with caution.
