预注地佐辛预防依托咪酯所致肌阵挛疗效和安全性的系统评价

I.V.Infusion of Dezocine before Etomidate Administration for Myoclonus of Prevention Caused by Etomidate: A Systematic Review

目的系统评价预注地佐辛预防依托咪酯所致肌阵挛的疗效和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2014年第6期)、CNKI、Wan Fang Data和VIP数据库,收集预注地佐辛预防依托咪酯所致肌阵挛的相关随机对照试验(RCT),检索时限截至2014年5月。由2位研究者按照纳入与排除标准独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用Rev Man 5.2.3软件进行Meta分析。结果共纳入10个RCT。Meta分析结果显示:1预注地佐辛能降低依托咪酯引起的肌阵挛发生率[RR=0.24,95%CI(0.12,0.45),P<0.000 1],且疗效优于芬太尼[RR=0.30,95%CI(0.17,0.51),P<0.000 1];2预注地佐辛能减少依托咪酯用量[MD=–4.70,95%CI(–6.62,-2.79),P<0.000 01];3地佐辛相对于芬太尼能减少注射痛发生率[OR=0.25,95%CI(0.10,0.62),P=0.003];4地佐辛不增加依托咪酯的呼吸抑制发生率[OR=2.61,95%CI(0.12,56.03),P=0.54]。结论预注地佐辛能降低依托咪酯诱导的肌阵挛发生率,减少依托咪酯用量,并优于芬太尼;其还能减少注射痛发生率,且未增加呼吸抑制发生率。

Objective To systematically assess the effectiveness and safety of I.V. infusion of dezocine for prevention of myoclonus caused by etomidate. Methods Databases including PubMed, EMbase, The Cochrane Library（Issue 6, 2014）, CNKI, WanFang Data and VIP were electronically searched from inception to May 2014 for randomized controlled trials（RCTs） on I.V. infusion of dezocine for prevention of myoclonus caused by etomidate. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using Rev Man 5.2.3 software. Results Ten RCTs were included. The results of meta-analysis indicated that, dezocine could reduce the incidence of myoclonus induced by etomidate（RR=0.24,95%CI 0.12 to 0.45, P〈0.000 1）, and was better than fentanyl（RR=0.30, 95%CI 0.17 to 0.51, P〈0.000 1）; dezocine could reduce the amount of etomidate（MD= –4.70, 95%CI-6.62 to-2.79, P〈0.000 01）; compared with fentanyl, dezocine could reduce the incidence of injection pain（OR=0.25, 95%CI 0.10 to 0.62, P=0.003）; dezocine did not increase the incidence of respiratory depression（OR=2.61, 95%CI 0.12 to 56.03, P=0.54）. Conclusion I.V. infusion of dezocine before etomidate administration could reduce myoclonus incidence caused by etomidate, reduce the amount of etomidate, and is better than fentanyl; which could also reduce the incidence of injection pain, and not increase the incidence of respiratory depression.