麻醉術前應用美托咪啶與咪唑安定隨機對照試驗的Meta分析_《中國循證醫學雜志》

作者：

孫捷豪 , 韓寧 ,  吳秀英

中國醫科大學盛京醫院麻醉科（沈陽 110004）;

關鍵詞：

美托咪啶咪唑安定隨機對照試驗

DOI：

10.7507/1672-2531.20090221

視頻：

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目的　比較美托咪啶和咪唑安定用于麻醉術前給藥的臨床效果和安全性。
方法　檢索公開發表的關于美托咪啶與咪唑安定用作麻醉前給藥的所有隨機對照試驗，按Cochrane 系統評價的方法，選擇試驗、評價質量，并采用RevMan4.2.10 軟件進行Meta 分析。
結果　共納入13 個研究，包括806 例患者。Meta 分析結果顯示，美托咪啶組與咪唑安定組相比能更好地降低術中的血壓和心率，減少麻醉藥使用量，縮短術后蘇醒時間，減少術后寒顫的發生率，但美托咪啶組在圍術期低血壓和心動過緩發生率明顯高于咪唑安定組，惡心嘔吐發生率兩組間差異無統計學意義。患者和手術醫生對兩者的滿意度、術后鎮靜評分、以及術后需鎮痛的人數，兩者差異均無統計學意義。
結論　美托咪啶作為麻醉前用藥與咪唑安定相比有優勢，除了圍術期低血壓和心動過緩發生率較高以外，美托咪啶有良好的臨床效果和安全性。

引用本文： 孫捷豪,韓寧,吳秀英. 麻醉術前應用美托咪啶與咪唑安定隨機對照試驗的Meta分析. 中國循證醫學雜志, 2009, 09(11): 1231-1237. doi: 10.7507/1672-2531.20090221 復制

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2.	Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54: 146.
3.	Virkkil? M, Ali-Melkkil? T, Kanto J, et al. Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo. Anaesthesia, 1994, 49: 853-858.
4.	Cheung CW, Ying CLA, Chiu WK, et al. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia, 2007, 62: 1132-1138.
5.	Alhashemi JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth, 2006, 96: 722-726.
6.	Karaas lan K, Yi lmaz F, Gul cu N, e t al . Compar i son of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: a prospective, randomized, double-blind, clinical study. Current Therapeutic Research, 2007, 68, 69-81.
7.	Koroglu A, Demirbilek S, Teksan H, et al. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth, 2005, 94: 821-824.
8.	Schmidt AP, Valinetti EA, Bandeira D, et al. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatr Anesth, 2007, 17: 667-674.
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10.	Demiraran Y, Korkut E, Tamer A, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol, 2007, 21: 25-29.
11.	Erkola O, Korttila K, Aho M, et al. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesth Analg, 1994, 79: 646-653.
12.	Jaakko L, Marja-Leena M, Harry S. Dexmede tomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anaesthesiology, 1995, 82: 1117-1125.
13.	Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J, 2004, 97, 451-455.
14.	Aantaa R, Jaakola ML, Kal l io A, et al . A compar i son of dexmedetomidine, and alpha 2-adrenoceptor agonist, and midazolam as i.m. premedication for minor gynaecological surgery. Br J Anaesth, 1991, 67(4): 402-409.
15.	Ustün Y, Gündüz M, Erdo?an O, et al. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg, 2006, 64(9): 1353-1358.
16.	Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
17.	Pandharipande PP, Pun BT, Herr DL, et al. Effect of Sedation with Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial. JAMA, 2007, 298: 2644-2653.
18.	Mattila MJ , Mattila ME, Olkkola KT, et al . Ef fect of dexmedetomidine and midazolam on human performance and mood. Eur J Clin Pharmacol, 1991, 41: 217-223.
19.	Angst MS, Ramaswamy B, Davies MF, et al. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology, 2004, 101: 744-752.

1. Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anaesthesia. Br J Anaesth, 1993, 71: 108.
2. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54: 146.
3. Virkkil? M, Ali-Melkkil? T, Kanto J, et al. Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo. Anaesthesia, 1994, 49: 853-858.
4. Cheung CW, Ying CLA, Chiu WK, et al. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia, 2007, 62: 1132-1138.
5. Alhashemi JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth, 2006, 96: 722-726.
6. Karaas lan K, Yi lmaz F, Gul cu N, e t al . Compar i son of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: a prospective, randomized, double-blind, clinical study. Current Therapeutic Research, 2007, 68, 69-81.
7. Koroglu A, Demirbilek S, Teksan H, et al. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth, 2005, 94: 821-824.
8. Schmidt AP, Valinetti EA, Bandeira D, et al. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatr Anesth, 2007, 17: 667-674.
9. Scheinin H, Jaakola ML, Sj?vall S, et al . Int ramuscular dexmedetomidine as premedication for general anesthesia. A comparative multicenter study. Anesthesiology, 1993, 78: 1065-1075.
10. Demiraran Y, Korkut E, Tamer A, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol, 2007, 21: 25-29.
11. Erkola O, Korttila K, Aho M, et al. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesth Analg, 1994, 79: 646-653.
12. Jaakko L, Marja-Leena M, Harry S. Dexmede tomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anaesthesiology, 1995, 82: 1117-1125.
13. Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J, 2004, 97, 451-455.
14. Aantaa R, Jaakola ML, Kal l io A, et al . A compar i son of dexmedetomidine, and alpha 2-adrenoceptor agonist, and midazolam as i.m. premedication for minor gynaecological surgery. Br J Anaesth, 1991, 67(4): 402-409.
15. Ustün Y, Gündüz M, Erdo?an O, et al. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg, 2006, 64(9): 1353-1358.
16. Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
17. Pandharipande PP, Pun BT, Herr DL, et al. Effect of Sedation with Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial. JAMA, 2007, 298: 2644-2653.
18. Mattila MJ , Mattila ME, Olkkola KT, et al . Ef fect of dexmedetomidine and midazolam on human performance and mood. Eur J Clin Pharmacol, 1991, 41: 217-223.
19. Angst MS, Ramaswamy B, Davies MF, et al. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology, 2004, 101: 744-752.

《中國循證醫學雜志》

麻醉術前應用美托咪啶與咪唑安定隨機對照試驗的Meta分析

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《中國循證醫學雜志》

麻醉術前應用美托咪啶與咪唑安定隨機對照試驗的Meta分析

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