Objectives: To evaluate the clinical value and safety of combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery.
Methods: The randomized controlled trials (RCTs) related to combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery were searched in PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP database, Wanfang database, ClinicalTrials.gov, and the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) from the inception of each database up to July 12, 2022. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool, and Meta-analysis was conducted using RevMan5.4.
Results: A total of 33 RCTs were included, involving 2 526 participants. The Meta-analysis results showed that compared to conventional anesthesia, the patients receiving combined anesthesia of acupuncture-pharmacotherapy had more stable vital signs during surgery, reduced intraoperative fentanyl usage [SMD=-3.73, 95%CI(-5.28, -2.18), Z=4.72, P<0.000 01], decreased postoperative sufentanil consumption [MD=-20.85, 95%CI(-24.84, -16.86), Z=10.24, P<0.000 01], reduced total/effective presses of the postoperative patient-controlled analgesia pump [MD=-5.70, 95% CI(-9.04, -2.36), Z=3.35, P=0.000 8], lowered postoperative pain visual analogue scale (VAS) [MD=-1.63, 95%CI(-2.02, -1.23), Z=7.97, P<0.000 01], shorter length of postoperative hospital stay [MD=-1.14, 95%CI(-1.85, -0.43), Z=3.15, P=0.002], and higher levels of CD 4+ T lymphocytes, CD 8+ T lymphocytes, natural killer (NK) cell activity, and superoxide dismutase (SOD). Additionally, tumor necrosis factor-alpha (TNF-α), adrenaline and cortisol levels were decreased (P<0.05). No adverse events related to acupuncture or electrical stimulation were reported, and the incidence of postoperative complications was lower than that of conventional anesthesia [RR=0.47, 95%CI(0.36, 0.62), Z=5.36, P<0.000 01].
Conclusions: The combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery could improve anesthesia and analgesia effectiveness, reduce anesthesia drug usage, regulate immune responses, suppress stress reactions, and the safety is satisfactory. However, there is substantial heterogeneity among the included studies, and outcome measures vary widely. Further large-sample, high-quality, internationally standardized clinical trials are needed to clarify its clinical value and safety, providing reliable evidence for clinical practice.
目的: 评价针药复合麻醉在肺切除手术应用中的临床价值及安全性。方法: 计算机检索 PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库（SinoMed）、中国期刊全文数据库（CNKI）、维普资讯中文期刊服务平台（VIP）、万方数据知识服务平台（Wanfang）、ClinicalTrials.gov、http：//www.chictr.org.cn/ 中关于针药复合麻醉在肺切除手术中应用的随机对照试验（RCT），检索时间从各数据库建库至2022年7月12日。采用Cochrane风险偏倚工具评估纳入文献的方法学质量，采用RevMan5.4进行Meta分析。结果: 纳入33篇RCT，总样本量为2 526例。Meta分析结果示：与常规麻醉比较，针药复合麻醉患者术中生命体征较平稳，术中芬太尼用量减少［SMD=-3.73，95%CI（-5.28，-2.18），Z=4.72，P<0.000 01］，术后镇痛泵舒芬太尼用量减少［MD=-20.85，95%CI（-24.84，-16.86），Z=10.24，P<0.000 01］，术后镇痛泵按压总/有效次数减少［MD=-5.70，95%CI（-9.04，-2.36），Z=3.35，P=0.000 8］，术后疼痛VAS评分降低［MD=-1.63，95%CI（-2.02，-1.23），Z=7.97，P<0.000 01］，术后住院天数更短［MD=-1.14，95%CI（-1.85，-0.43），Z=3.15，P=0.002］，Ｔ淋巴细胞表面抗原CD 4+ 、Ｔ淋巴细胞表面抗原CD 8+ 、自然杀伤细胞（NK）活性、超氧化物歧化酶水平升高（P<0.05），肿瘤坏死因子-α（TNF-α）、肾上腺素、皮质醇水平降低（P<0.05）；针药复合麻醉患者未发生针刺/电刺激不良反应，术后并发症低于常规麻醉［RR=0.47，95%CI（0.36，0.62），Z=5.36，P<0.000 01］。结论: 针药复合麻醉介入肺切除手术可提高麻醉镇痛效果，减少麻醉药用量，调节机体免疫，抑制应激反应，安全性好。但纳入的研究间异质性较大，结局指标选用差异性较大，仍需采用大样本、高质量、符合国际规范的临床试验方案，进一步明确其临床价值及安全性，为临床提供可靠的循证证据。.
Keywords: Meta-analysis; combined anesthesia of acupuncture-pharmacotherapy; pulmonary resection surgery; systematic review.