艾司洛尔与芬太尼族药物在预防喉镜和气管插管时心血管反应疗效的Meta分析

The Effects of Esmolol or Fentanyl Family of Drugs for Attenuating the Hemodynamicresponse to Laryngoscopy and Tracheal Intubation: A Meta-Analysis

目的系统评价艾司洛尔在预防喉镜和气管插管所致心血管反应的疗效是否等同或优于芬太尼族药物。方法计算机检索Pubmed、Embase、The Cochrane Library、CNKI、维普、生物医学文献、万方等数据库,检索时间截止至2014年7月。由两名评价者按照纳入与排除标准以及Cochrane协作网推荐的方法独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入14个随机对照研究,640名接受喉镜和气管插管的受试者。Meta分析结果表明,艾司洛尔与芬太尼族药物在减慢心率和降低平均动脉压方面等效(P>0.05),但在降低收缩压[MD=14.93;95%CI(7.30,22.55),P=0.000 1]和舒张压[MD=21.40;95%CI(12.29,30.51),P<0.000 01]方面,芬太尼族药物优于艾司洛尔。结论相对于艾司洛尔来说,芬太尼族药物在预防喉镜和气管插管时的心血管反应方面更具优势,但应用时尽量选择中低剂量,同时监测血压,谨防低血压的发生。

OBJECTIVE To evaluate whether esmolol is equivalent with or superior to fentanyl family of drugs （Fentanyls） on blunting the hemodynamic response to laryngoscopy and tracheal intubation （ LTI）. METHODS Such databases as PubMed, Em- base, The Cochrane Library, CNKI, VIP, CBM, and WanFang Data were electronically searched for relevant studies from inception to July, 2012. According to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration, two reviewers independently screened literatures, extracted data, and assessed the methodological quality of the included studies. Then, Meta-analysis was performed using RevMan 5.2 software. RESULTS Finally, 14 randomized controlled trials （RCT） involving 640 patients were included. The results of Meta-analysis showed no significant difference in controlling both heart rate （HR） and mean arterial pressure （MAP） （P 〉 0.05 ）. However, the Fentanyls group was superior to esmolol group in reducing the systolic blood pres- sure （SBP） [ MD = 14. 93 ; 95% CI （7.30, 22. 55 ） , P = 0. 000 1 ] , and the diastolic blood pressure （DBP） [ MD = 21.40 ; 95% CI （ 12. 29, 30. 51 ） , P 〈 0. 000 01 ]. CONCLUSION Based on current evidence, Fentanyls tends to have more beneficial effects on attenuating the hemodynamic response to laryngoscopy and tracheal intubation, compared with esmolol. And choosing middle-lowerd dosage, monitoring of blood pressureafter administrating Fentanyls are important to avoid emergency during LTI.