盐酸右美托咪啶对颅脑手术患者脑保护作用的Meta分析

Meta-analysis of Dexmedetomidine for cerebral protection during intracranial procedures

目的评价盐酸右美托咪啶作为颅内手术患者辅助用药的有效性和安全性，为颅脑手术患者围术期麻醉用药提供良好的方案。方法检索PubMed、Cochrane Library、Medicine、Web of Science、中国期刊全文数据库（CNKI）等生物医学数据库，收集有关盐酸右美托咪啶作为颅脑手术围术期辅助用药的随机对照试验，分组中对照组为安慰剂组，提取资料中相关的有效数据，使用RevMan5．3软件行Meta分析。结果最终纳入9项随机对照试验，共374例患者。Meta分析结果显示：与安慰剂组比较，使用盐酸右美托咪啶术中围术期高血压和低血压发生率更低（RR=0．45，95％CI：0．29～069，P=0．0003；RR=0．66，95％CI：0．43～1．00，P=0．05），患者在拔管时有更低的平均动脉压和心率（MD=10．02，95％CI：8．00～12．35，P〈0．00001；MD=20．17，95％CI：12．28～28．07，P〈0．00001）。结论盐酸右美托咪啶用于颅脑手术围术期辅助用药可以提供稳定的血流动力学。

Objective To assess the efficacy and safety of Dexmedetomidine （DEX） as an anesthetic adjuvant and pro- vide good therapeutic regimen for patients undergoing intracranial procedures. Methods The related literatures were searched from the database by computer in PubMed, Cochrane Library, Medicine, Web of Science, CBM and CNKI. Randomized controlled trials （RCTs） were collected about DEX for intracranial surgery, the control group was placebo group. Significant data was extracted from these trials and analyzed by RevMan5.3 software. Results A total of nine RCTs involving 374 patients were included. Meta-analysis showed that, patients treated with DEX showed lower incidence of hypertension and hypotension （RR = 0.45, 95%CI： 0.29-069, P = 0.0003; RR = 0.66, 95%CI： 0.43-1.00, P = 0.05） compared with placebo. Patients also had lower mean arterial pressure and heart rate when extubated [MD = 10.02, 95%CI： 8.00-12.35, P 〈 0.000 01; MD = 20A7, 95%CI： 12.28-28.07, P 〈 0.000 01）. Conclusion Meta-analysis showed that DEX as an anesthetic adjuvant during intracranial procedures stabilized perioperative hemodynamic.