心臟手術后右美托咪定鎮靜效果的Meta分析_《中國循證醫學雜志》

作者：

王麗美 , 常小麗 , 任許利 ,  呂黃偉

中國醫科大學附屬第一醫院麻醉科（沈陽 110001）;

關鍵詞：

右美托咪定心臟手術術后鎮靜并發癥 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20130017

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價心臟手術后右美托咪定鎮靜的療效和安全性。
方法　計算機檢索PubMed、EBSCO、Springer、Ovid、Cochrane Library、CNKI、VIP和Wanfang Data，同時手工檢索相關專業雜志并追溯納入文獻的參考文獻，檢索時限均為建庫至2012年5月。由兩名評價者按照納入與排除標準選擇試驗、提取資料和評價質量后，采用RevMan 5.1軟件進行Meta分析。
結果　納入8個隨機對照試驗（RCT），共1 157例患者。7個RCT的Jadad評分 gt;3分，僅1個為2分。Meta分析結果顯示：與對照組比較，右美托咪定更能提高末梢血氧飽和度［RR=0.90，95%CI（0.31，0.49），P=0.003］，降低平均心率［RR=–5.86，95%CI（–7.31，–4.40），P lt;0.000 01］、室性心動過速［RR=0.27，95%CI（0.08， 0.88），P=0.03］、躁動［RR=0.28，95%CI （0.16，0.48），P lt;0.000 01］、高血糖［RR=0.57，95%CI（0.38，0.85），P=0.006］的發生率，還能減少需要腎上腺素［RR=0.53，95%CI（0.29，0.96），P=0.04］及β-受體阻滯劑支持的患者數［RR=0.60，95%CI （0.38，0.94），P=0.03］。但右美托咪定并不能縮短心臟術后患者ICU住院時間［RR=–1.24， 95%CI（–4.35， 1.87），P=0.43］和機械通氣時間［RR=–2.28，95%CI（–5.13，0.57），P=0.12］，也不能提高平均動脈壓［RR=–2.78，95%CI（–6.89，1.34），P=0.19］，且對術后惡心嘔吐和房顫的控制效果不佳。此外，兩組患者在心肌梗死、急性心衰、急性腎衰及病死率方面，差異無統計學意義。
結論　右美托咪定用于心臟手術術后鎮靜時可明顯穩定血流動力學指標，降低室性心動過速、躁動及術后高血糖的發生率并減少血管活性藥物的應用，但對患者預后無明顯影響。由于納入研究的數量和質量有限，本研究結論尚需高質量、大樣本的RCT證實。

引用本文： 王麗美,常小麗,任許利,呂黃偉. 心臟手術后右美托咪定鎮靜效果的Meta分析. 中國循證醫學雜志, 2013, 13(1): 93-99. doi: 10.7507/1672-2531.20130017 復制

1.	Gregory B, Hammer MD, The role of alpha2 agonists in pediatric anesthesia. Canadian Journal of Anesthesia, 2005, 52(6): R1–R3.
2.	Virtanen R, Savola JM, Saano V, et al. Characterization of theselectivity, specificity and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol, 1988, 150(1-2): 9-14.
3.	Maze M, Scheinin M. Molecular pharmacology of a2-adrenergic receptors. Anaesth Pharmacol Rev, 1993, 1(4): 233-237.
4.	Shehabi Y, Ruettimann U, Adamson H, et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med, 2004, 30(12): 2188-2196.
5.	Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med, 2003, 29(2): 201-207.
6.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reportsof randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7.	Stephanie MC, Jill A, Christopher M, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
8.	Noorizan AA, Mui CC, Chow YY, et al. Efficacy and safety of dexmedetomidine versus morphinein post-operative cardiac surgery patients. Int J Clin Pharm, 2011, 33: 150-154.
9.	Daniel L, John SP, Michael E, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine based versus propofol-based sedation regimens. Journal of Cardiothoracic and Vascular Anesthesia, 2003, 17(50): 576-584.
10.	Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine domppared with morphine based therapy after cardiac surgery. Anesthesiology, 2009, 111(5): 1075–1084.
11.	胡雪蓮, 賈明, 趙勇, 等. 右美托咪啶和咪達唑侖在心臟術后鎮靜作用的研究. 寧夏醫學雜志, 2011, 33(10): 967-969.
12.	Jose R, Ashley W, Pieter JA, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
13.	Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of dexmedetomidine versus propofol-based sedation therapy in mechanically ventilated cardiac surgery patients at a tertiary academic medical center. Critical Pathways in Cardiology, 2010, 9(4): 222-226.
14.	Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. The Heart Surgery Forum, 2011, 14(2): E93-E98.
15.	孫捷豪, 韓寧, 吳秀英. 美托咪啶用于全身麻醉的隨機對照試驗的Meta分析. 中國循證醫學雜志, 2008, 8(9): 773-778.
16.	Siobal MS, Kallet RH, Kivett VA, et al. Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir Care, 2006, 51(5): 492-496.
17.	MacLaren R, Forrest LK, Kiser TH. Adjunctive dexmedetomidine therapy in the intensive care unit: a retrospective assessment of impact on sedative and analgesic requirements, levels of sedation and analgesia, and ventilatory and hemodynamic parameters. Pharmacotherapy, 2007, 27(3): 351-359.
18.	Arpino PA, Kalafatas K, Thompson BT. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. J Clin Pharm Ther, 2008, 33(1): 25-30.

1. Gregory B, Hammer MD, The role of alpha2 agonists in pediatric anesthesia. Canadian Journal of Anesthesia, 2005, 52(6): R1–R3.
2. Virtanen R, Savola JM, Saano V, et al. Characterization of theselectivity, specificity and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol, 1988, 150(1-2): 9-14.
3. Maze M, Scheinin M. Molecular pharmacology of a2-adrenergic receptors. Anaesth Pharmacol Rev, 1993, 1(4): 233-237.
4. Shehabi Y, Ruettimann U, Adamson H, et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med, 2004, 30(12): 2188-2196.
5. Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med, 2003, 29(2): 201-207.
6. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reportsof randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7. Stephanie MC, Jill A, Christopher M, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
8. Noorizan AA, Mui CC, Chow YY, et al. Efficacy and safety of dexmedetomidine versus morphinein post-operative cardiac surgery patients. Int J Clin Pharm, 2011, 33: 150-154.
9. Daniel L, John SP, Michael E, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine based versus propofol-based sedation regimens. Journal of Cardiothoracic and Vascular Anesthesia, 2003, 17(50): 576-584.
10. Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine domppared with morphine based therapy after cardiac surgery. Anesthesiology, 2009, 111(5): 1075–1084.
11. 胡雪蓮, 賈明, 趙勇, 等. 右美托咪啶和咪達唑侖在心臟術后鎮靜作用的研究. 寧夏醫學雜志, 2011, 33(10): 967-969.
12. Jose R, Ashley W, Pieter JA, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
13. Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of dexmedetomidine versus propofol-based sedation therapy in mechanically ventilated cardiac surgery patients at a tertiary academic medical center. Critical Pathways in Cardiology, 2010, 9(4): 222-226.
14. Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. The Heart Surgery Forum, 2011, 14(2): E93-E98.
15. 孫捷豪, 韓寧, 吳秀英. 美托咪啶用于全身麻醉的隨機對照試驗的Meta分析. 中國循證醫學雜志, 2008, 8(9): 773-778.
16. Siobal MS, Kallet RH, Kivett VA, et al. Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir Care, 2006, 51(5): 492-496.
17. MacLaren R, Forrest LK, Kiser TH. Adjunctive dexmedetomidine therapy in the intensive care unit: a retrospective assessment of impact on sedative and analgesic requirements, levels of sedation and analgesia, and ventilatory and hemodynamic parameters. Pharmacotherapy, 2007, 27(3): 351-359.
18. Arpino PA, Kalafatas K, Thompson BT. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. J Clin Pharm Ther, 2008, 33(1): 25-30.

《中國循證醫學雜志》

心臟手術后右美托咪定鎮靜效果的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

Format

Content

《中國循證醫學雜志》

心臟手術后右美托咪定鎮靜效果的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料