右美托咪定与咪达唑仑在小儿术前用药效果的Meta分析

Compare the efficacy of dexmedetomidine versus midazolam as a pediatric anesthetic premedication:a meta-analysis

目的 采用Meta分析比较右美托咪定与咪达唑仑在小儿术前用药的效果.方法 检索Cochrane图书馆、Pubmed、Embase,检索时间从建库至2014年5月.收集在小儿术前用药中使用右美托咪定与咪达唑仑的临床随机对照试验（RCT）.采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan 5.0软件对收集的患儿资料进行Meta分析评价.结果 共纳入10项研究,包括721例患儿,其中右美托咪定组375例,咪达唑仑组346例.与咪达唑仑组比较,右美托咪定组术前镇静效果更好,分别体现在亲子分离时（OR=1.71,95％CI 1.07～2.74）及麻醉诱导时（OR=2.34,95％CI 1.44～3.80）,而且右美托咪定组患儿术后镇痛补救（OR=0.45,95％CI 0.28～0.72）及寒颤的发生率（OR=0.22,95％CI 0.06～0.77）都较低.结论 相对于咪达唑仑,小儿右美托咪定术前用药可能是一种更好的选择.

Objective To compare the efficacy of dexmedetomidine versus midazolam as a pediatric anesthetic premedication.Methods We searched the PubMed,Embase,Cochrane library,for all randomized controlled trials（RCTs）about the efficacy of premedication with dexmedetomidine versus midazolam in pediatric patients.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Meta-analysis was conducted using the Cochrane Collaboration＇s RevMan 5.0 software.Results Ten original RCTs investigating a total of 721 patients,of whom 375 received dexmedetomidine and 346 received traditional midazolam,met the inclusion criteria.Dexmedetomidine use was associated with better sedation at the time of child-parent separation（OR=1.71,95％ CI 1.07-2.74） and induction of anesthesia（OR=2.34,95％ CI 1.44-3.80）,less additional analgesics rescue （OR=0.45,95％ CI 0.28-0.72）,and less shivering occurrence （OR=0.22,95％ CI 0.06-0.77）.Effects of dexmedetomidine on anesthesia mask application,emergence agitation,nausea/ vomiting and recovery were not found to be significantly different from those of midazolam.Conclusion Dexmedetomidine is a safe and effective sedative agent for pediatric anesthetic premedication.Compared with midazolam,dexmedetomidine provided more smooth sedation,less postoperative analgesics rescue and shivering occurrence.