右美托咪定或瑞芬太尼联合表面麻醉用于清醒气管插管术的安全性：meta分析

Safety of dexmedetomidine- or remifentanil-based topical anesthesia for awake intubation： a metaanalysis

目的采用meta分析比较右美托咪定或瑞芬太尼联合表面麻醉用于清醒气管插管术的安全性。方法计算机检索PubMed、EMBASE、Webof Science、CochraneLibrary、中国生物医学文献数据库、中国知网及万方数据库，检索时间从1990年1月至2016年4月，纳入研究右美托咪定和瑞芬太尼联合表面麻醉用于清醒气管插管术的随机对照试验。对纳入文献提取以下信息：首次气管插管成功情况、高血压、低血压、心动过缓、心动过速、呼吸抑制、呛咳、体动反应、咽痛、声嘶和气管插管不良记忆的发生情况。采用RevMan5．3软件进行meta分析。结果共纳入10项研究，528例患者，其中右美托咪定组262例，瑞芬太尼组266例。与瑞芬太尼组比较，右美托咪定组呼吸抑制和气管插管不良记忆的发生率降低（P〈0．05），首次气管插管成功率、高血压、低血压、心动过缓、心动过速、呛咳、体动反应、咽痛和声嘶的发生率比较差异无统计学意义（P〉0．05）。结论右美托咪定联合表面麻醉用于清醒气管插管术的安全性高于瑞芬太尼。

Objective To compare the safety of dexmedetomidine- versus remifentanil-based topi- cal anesthesia for awake intubation. Methods PubMed, EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Database, CNKI and Wanfang Database were searched from January 1990 to April 2016 for randomized controlled trials involving the safety of dexmedetomidine- and remifentanil-based topical anes- thesia for awake intubation. The following data were extracted： the rate of successful intubation at first attempt and development of hypertension, hypotension, bradycardia, tachyeardia, respiratory depression, bucking, body movement, sore throat, hoarseness and postsurgieal memory of intubation. Meta-analysis was conducted using the RevMan 5.3 software. Results Ten studies involving 528 patients were included in this meta-analysis, and there were 262 cases in dexmedetomidine group and 266 cases in remifentanil group. Compared with remifentanil group, the incidence of respiratory depression and postsurgical memory of intubation were significantly decreased （P〈0.05）, and no significatat change was found in the rate of successful intubation at first attempt and incidence of hypertension, hypotension, bradycardia, tachycardia, bucking, body movement, sore throat and hoarseness in dexmedetomidine group （P〉0.05）. Conclusion Dexmedetomidine-based topical anesthesia provides higher safety than remifentanil-based topi- cal anesthesia when used for awake intubation.