| Purpose: This study aimed to compare the anesthetic effects of sufentanil and fentanyl in heart valve surgery by meta-analysis.Methods: Using sufentanil,fentanyl,heart valvular disease,heart valve surgery,sufentanil,fentanyl,valvular heart disease,VHD,cardiac valve surgery,heart valve surgery,etc.as search terms,Chinese biomedical literature was retrieved through the computer system Database,China How Net,Wanfang Database,Weipu Chinese Database,Pub Med,Embase,Cochrane Library,Medline,Wiley Online Library,Google Scholar and Web of Science,the search time is limited to the establishment of the database until February 2020.Two researchers independently screened the literature,evaluated the quality of the literature and extracted the required data.A random effect model was used to summarize and analyze the data,and standardized differences(SMD)and 95%confidence intervals(CI)were used to compare the differences between groups.In addition,Begg ’s Test and funnel charts were used to assess publication bias,and sensitivity and subgroup analysis of the study results were performed.Results: This study included 15 randomized controlled trials(RCT)involving 596 patients with VHD.Among them,307 patients were assigned to the sufentanil group,and 289 patients were assigned to the fentanyl group.The meta-analysis results showed that sufentanil significantly reduced heart rate immediately after skin incision(SMD =-0.60,95% CI:-1.14 ～-0.06)and recovery time(SMD =-2.14,95%)CI:-2.93 ～-1.36),extubation time(SMD =-2.67,95% CI:-4.65 ～-0.69),6-hour visual analogue scale(VAS)(SMD =-1.08,95% CI:-2.01 ～-0.15),30 minutes of aortic open hypersensitivity troponin(c Tn I)(SMD =-0.72,95% CI:-1.08 ～-0.37),c Tn I at the end of the operation(SMD =-1.37,95 % CI:-2.44 ～-0.30),c Tn I with CPB down for 4 hours(SMD=-1.04,95% CI:-1.62 ～-0.45),creatine kinase isozyme with aorta open for 30minutes(CK-MB)(SMD =-1.11,95% CI:-1.98 ～-0.24),CK-MB with 6 hours of shutdown(SMD =-1.58,95% CI:-2.08 ～-1.07)and CK with 24 hours of shutdown-MB(SMD =-0.97,95% CI:-1.43 ～-0.50).There was no significant difference in heart rate at 5 minutes after intubation,heart rate at the end of the operation,systolic blood pressure immediately after skin incision,diastolic blood pressure immediately after skin incision,central venous pressure immediately after shutdown,cardiac index immediately after shutdown,ventilator use time,ICU stay time,CTn I with CPB shut down for 24 hours and CK-MB with aortic opening immediately between the two groups.Conclusion: The results of this meta-analysis showed that,compared with fentanyl,sufentanil was more advantageous in shortening postoperative recovery time and extubation time,and reducing VAS,CK-MB and c Tn I in patients undergoing cardiac valve surgery,and could obtain better clinical benefits.There was no significant difference in hemodynamics,postoperative ventilator use time and ICU stay time between the two groups.However,in view of the limitations of the included population,sample size,and included indicators in this study,more randomized controlled trials are still needed to confirm this conclusion. |
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