右美托咪定对体外循环心脏手术病人心肌缺血再灌注损伤的影响：meta分析

Effect of dexmedetomidine on myocardial ischemia-reperfusion injury in patients undergoing cardiac surgery with cardiopulmonary bypass： a meta-analysis

目的采用meta分析评价右美托咪定对体外循环心脏手术病人心肌缺血再灌注损伤的影响。方法计算机检索中国学术期刊网络出版总库、中国生物医学文献数据库、万方数据库、中文科技期刊数据库、Pubmed及Cochrane Library，纳入研究右美托咪定对体外循环心脏手术病人心肌保护作用的随机对照试验。对纳入文献提取以下信息：收集劈胸骨时平均动脉压和心率、术中心脏自动复跳情况、术后6、24和48h时血浆CK—MB及cTnI浓度和术后24h时心率。采用RevMan5．3软件对进行meta分析。结果共纳入12项研究。与对照组比较，右美托咪定组术后6、24和48h时血浆cTnI浓度、术后6和24h时血浆CK—MB浓度降低，劈胸骨时平均动脉压和心率降低，术后24h时心率降低，心脏自动复跳率升高（P〈0．05）。结论右美托咪定可减轻体外循环心脏手术病人心肌缺血再灌注损伤。

Objective To evaluata the effect of dexmedetomidine on myocardial ischemia-reperfusion injury in the patients undergoing cardiac surgery with cardiopulmonary bypass： a meta-analysis. Methods We searched the China Integrated Knowledge Resources Database, Chinese Biomedical Database, Wanfang Database, Weipu, PubMed, Cochrane Library （from inception to July 2015） to identify randomized controlled trials involving dexmedetomidine-induced cardioprotection in the patients undergoing cardiac surgery with cardiopulmonary bypass. The following data were extracted from the trials included： the mean arterial pressure and heart rate at breast bone splitting, the spontaneous recovery of heart beat during sur- gery, the plasma concentrations of ereatine kinase-MB and cardiac troponin I at 6, 24 and 48 h after surgery, and heart rate at 24 h after surgery. Meta-analysis was conducted using the Cochrane Collaboration＇s RevMan 5.3 software. Results Twelve prospective randomized controlled trials involving 750 patients were included in this meta-analysis. The patients were divided into 2 groups： dexmedetomidine group （n = 376） and control group （n = 374）. Compared with control group, the plasma caradiac troponin I concentrations at 6, 24, and 48 h after surgery, and creatine kinase-MB concentrations at 6 and 24 h after surgery were significantly decreased, the mean arterial pressure and heart rate were decreased at breast bone splitting, heart rate was decreased at 24 h after surgery, and the percentage of spontaneous recovery of heart beat wasincreased in dexmedetomidine group （P〈0.05）. Conclusion Dexmedetomidine can mitigate myocardial ischemia-reperfusion injury in the patients undergoing cardiac surgery with cardiopulmonary bypass.