右美托咪啶对小儿七氟醚麻醉苏醒期躁动的Meta分析

The Meta-analysis of dexmedetomidine on prevention of emergence agitation after sevoflurane anesthesia in pediatric patients

目的系统评价右美托咪啶是否可以降低七氟醚麻醉引起的小儿苏醒期躁动的发生率。方法计算机检索Cochrane Library、PubMed、EBSCO、Springer、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普(VIP)、万方数据库,手工检索纳入文献的相关参考文献,检索时限均为建库至2013年4月。由两名评价者按照纳入与排除标准选取临床随机对照试验、提取资料和评价文献质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入26个随机对照试验,1842例患儿。Meta分析结果显示,与安慰剂相比,右美托咪啶可显著降低患儿苏醒期躁动的发生率[RR=0.31,95%CI(0.26,0.38)]及躁动评分[MD=-0.89,95%CI(-1.04,-0.74)],对小儿呛咳的发生率[RR=0.39,95%CI(0.23,0.68)]有一定的预防作用;所有纳入的文献均未见呼吸、循环系统方面的严重不良反应。结论右美托咪啶可安全用于小儿,显著降低小儿苏醒期躁动的发生率,并降低躁动评分,对呛咳的发生可能也有一定的预防作用。

Objective To evaluate whether dexmedetomidine can decrease emergence agitation in pediatric patients after sevoflurane anesthesia.Methods The Coehrane Library,PubMed,EBSCO,Springer, Chinese Journal Full-text Database （CNKI）,Chinese Biomedical Literature Database （CBM）,VIP and WanFang Data （from the date of establishment of the databases to April 2013） were searched,reference lists of all studies were also checked.Two reviewers independently performed study selection,quality assessment,and data extraction,the Meta-analysis was conducted with RevMan 5.2 software.Results A total of 26 randomized controlled trials involving 1842 cases of children were included. The Meta-analysis showed,compared with placebo,dexmedetomidine could significantly decrease the incidence of emergence agitation [RR=0.31,95%CI （0.26,0.38）],and could reduce agitation score [MD=-0.89,95%CI （-1.04,-0.74）]. What＇s more,on reducing occurrence of bucking [RR=0.39,95%CI （0.23,0.68）],dexmedetomidine also showed some preventive effects.There were no serious side effects on respiratory and circulatory system in all included studies.Conclusion Dexmedetomidine can be used safely and significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.