右美托咪定与芬太尼类药物在清醒气管插管患者麻醉诱导效果比较的 Meta 分析

Comparison of anesthesia induction efficacy of dexmedetomidine with fentanyl-class drugs in patients undergoing awake intubation:a meta-analysis

目的：采用 Meta 分析比较右美托咪定与芬太尼类药物在清醒气管插管患者中麻醉诱导的效果。方法检索 Cochrane 图书馆、PubMed、Embase、中国生物医学文献数据库（CBM）、CNKI、维普、万方数据库，检索时间从1990年至2014年2月。收集清醒气管插管患者使用右美托咪定与常用芬太尼类药物（芬太尼、舒芬太尼、瑞芬太尼）作为麻醉诱导的临床随机对照研究（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软件对收集的患者资料进行 Meta 分析评价。结果纳入10篇研究400例患者，其中右美托咪定组197例，芬太尼类药物组203例。在插管前即刻右美托咪定组患者的镇静效果（RSS 评分）明显优于芬太尼类药物组（WMD 1.29，95％CI 1.02～1.56），插管完成即刻右美托咪定组的镇静效果（RSS 评分）同样优于芬太尼类药物组（WMD 1.41，95％CI 1.10～1.72）。右美托咪定组呛咳反射发生率明显低于芬太尼类药物组（OR 0.10，95％CI 为0.03～0.31）。右美托咪定组高血压发生率明显低于芬太尼类药物组（OR 0.25，95％CI 0.11～0.57）。右美托咪定组呼吸抑制发生率明显低于芬太尼类药物组（OR 0.33，95％CI 0.16～0.72）。右美托咪定组术后不良记忆发生率明显低于芬太尼类药物组（OR 0.50，95％CI 0.28～0.92）。结论与芬太尼类药物比较，右美托咪定用于清醒气管插管更具有优势。

Objective To systematically review the efficacy of dexmedetomidine and fentanyl-class drugs for induction in awake intubation patients.Methods We searched the PubMed,Embase, Cochrane library,Wanfang Database,CNKI,VIP and China Biology Medicine （CBM）for all ran-domized controlled trials （RCTs）about the efficacy of dexmedetomidine versus drugs of fentanyl class （fentanyl,sufentanil,remifentanil）for induction in awake intubation patients.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Meta-analysis was con-ducted using the Cochrane Collaboration＆#39;s RevMan 5.0 software.Results Ten RCTs involving 400 patients were included in our Meta-analysis.The results of meta-analysis showed that the ramsay se-dation scores in awake intubation patients was higher in group dexmedetomidine than that of group fentanyl-class drugs （P〈0.05）.Compared with group fentanyl-class drugs,the incidence of compli-cations such as hypertension,respiratory depression,bucking and post-surgical memory in the group dexmedetomidine was lower （P〈0.05）.Conclusion The efficacy of dexmedetomidine is better than that fentanyl-class drugs for induction in awake intubation patients.