中图分类号：R619；R614 文献标识码：A 文章编号：1000-503X（2025）03-0434-07

DOI：10.3881/j. issn.1000-503X.16159

Effects of Total Intravenous Anesthesia and Inhalational Anesthesia on Postoperative Recovery in Patients Undergoing Transsphenoidal Pituitary Surgery ： A Systematic Review

FENG Yunying'， ZHANG Yupei²， ZHANG Yuelun³， XING Bing4，LIAN Wei4， GUO Xiaopeng4，MA Lulu'， HUANG Yuguang

¹ Department of Anesthesiology， ² Department of Pulmonary and Critical Care Medicine， ³ Center for Prevention and Early Intervention， NationalInfrastructuresforTranslationalMedicine，InstituteofClinicalMedicine，Departmentof Neurosugery，PUHospial， CAMS and PUMC，Beijing 100730，China

Corresponding author：MA Lulu Tel：O10-69152020，E-mail：malulu@pumch.cn

ABSTRACT：ObjectiveTo systematically evaluate the effects of total intravenous anesthesia and inhalational anesthesia onpostoperative recovery in patients undergoing transsphenoidal pituitary tumor resection.MethodsA comprehensivesearch wasconducted in international biomedical databases including Ovid Medline，Embase，CINAHL （EBSCO），Cochrane Library，and Web of Science，from inception to July 4， 2023.Aditionally，ClinicalTrials.govand the World Health Organization International Clinical Trials Registry Platform were searched for ongoing and completed trials.The randomized controlled trials（RCT）comparing total intravenous anesthesia andinhalational anesthesia in patientsundergoing transshenoidal surgery forpituitary tumors were included.The methodological qualityof the included studies was evaluated by the Cochrane Collaboration tool.Relevant data were extractedand synthesized foranalysis.ResultsAtotal of327records were identified，of which eight RCTs met the inclusion criteria.Four studies showed that the patients receiving desflurane or sevoflurane anesthesia experienced faster emergence from anesthesia than those receiving propofol.Two studies indicated that patients in the propofol group had lower levels of emergence agitation anda lower incidence of early postoperative nausea and vomiting.The results on postoperative cognitive function were inconsistent across studies.No differences were found between the groups in terms of postoperativecomplications or overallrecoveryquality during hospitalization. ConclusionsInhalational anesthesia appears to provide an advantage in promoting faster emergence following transsphenoidal pituitary surgery，whereas total intravenous anesthesia maycontribute to smootherand more stablerecovery.Further high-qualitystudiesareneeded to clarifytheefects of diferent anesthetic techniques on both short- and long-term postoperative recovery.

Keywords：inhalational anesthesia；total intravenous anesthesia；pituitary tumor；postoperative recovery

ActaAcadMedSin，2025，47（3）：434-440

垂体瘤是常见的原发性脑肿瘤，占成人鞍区病变的 90% [1]，根据激素分泌类型分为无功能性腺瘤和功能性腺瘤（包括催乳素腺瘤、生长激素腺瘤、促肾上腺皮质激素腺瘤、促甲状腺激素腺瘤等）[2]。1907 年奥地利外科医生Schloffer[3]报道1例成功实施经鼻蝶入路垂体瘤切除手术的病例，之后该术式在垂体外科得到长足发展[4]。经鼻蝶入路术式能够通过鼻腔这一通道快速、直接到达鞍区，具有创伤小、术后恢复较快的优势[5]，目前是可切除垂体瘤的首选治疗方式[6]，但同时对手术麻醉的需求量也大幅增加。吸人麻醉和基于丙泊酚的全静脉麻醉是临床上最常用的两种全身麻醉方法，尽管已有较多研究探讨了他们在不同类型手术中的差异，但这些研究多为回顾性分析，且对于经鼻蝶人路垂体瘤切除手术的麻醉选择尚无明确定论[7-9]。近年来，越来越多的前瞻性研究报道经鼻蝶入路垂体瘤手术中采用不同麻醉方式对患者术后恢复的影响[10-12]。如何确保经鼻蝶入路垂体瘤切除术患者的平稳麻醉和术后快速康复是当前亟待解决的关键问题。本研究系统评价全静脉麻醉与吸人麻醉对经鼻蝶入路垂体瘤切除术患者术后恢复的影响，以期为临床实践及后续相关领域研究提供参考依据。

1资料和方法

本研究依据系统综述和meta分析优先报告条目（preferredreportingitemsforsystematicreviewsand meta-analyses，PRISMA）规范[13]进行报告，研究方案已在PROSPERO平台注册（注册编码：CRD42023441491）。

1.1 纳入和排除标准

纳人标准：（1）研究设计：随机对照试验（ran-domizedcontrolledtrial，RCT）；……