右美托咪定对单肺通气患者炎性反应和氧合指数影响的Meta分析

Effects of dexmedetomidine on inflammatory response and oxygenation index in patients with one lung ventilation： a Meta analysis

目的 探讨右美托咪定（dexmedetomidine,Dex）对单肺通气患者炎性反应和氧合指数的影响.方法 计算机检索The Cochrane Library、PubMed、EMBASE、CNKI和Wanfang Data数据库,同时手工检索图书馆馆藏期刊,收集有关Dex对单肺通气患者炎性反应和氧合指数影响的随机对照试验（randomized controlled trail,RCT）.由两位研究者按照纳入与排除标准筛选文献、提取资料和评价质量,采用RevMan 5.3软件进行Meta分析.结果 最终纳入23个RCT,共1082例患者.Meta分析结果显示：①与对照组比较,Dex降低患者TNF-α水平[单肺通气30 min,标准化均数差（standardized mean difference,SMD）=-0.53,95％CI（-1.02,-0.05）,P=0.03;单肺通气60 min,SMD=-1.90,95％CI（-2.19,-1.60）,P〈0.05]、IL-6水平[单肺通气30 min,SMD=-0.64,95％CI（-0.86,-0.42）,P〈0.05;单肺通气60 min,SMD=-1.30,95％CI（-1.56,-1.04）,P〈0.05]和IL-8水平[单肺通气30 min,SMD=-0.80,95％CI（-1.14,-0.46）,P〈0.05;单肺通气60 min,SMD=-1.32,95％CI（-1.73,-0.91）,P〈0.05].②与对照组比较,Dex降低患者PaO2/FiO2[单肺通气60 min,均数差（mean difference,MD）=52.69,95％CI（25.89,79.49）,P〈0.05].结论 Dex能够有效减轻围手术期单肺通气患者的炎性反应并改善氧合指数.受纳入研究数量和质量限制,上述结论尚需进一步开展大样本、多中心、高质量的RCT加以验证.

Objective To evaluate the effects of dexmedetomidine （Dex） on inflammatory response and oxygenation in patients with one lung ventilation. Methods We searched the Cochrane Controlled Trial Registers（CCTR）of the Cochrane Library, PubMed, EMBASE, CNKI, and Wanfang Data published before November 2016. We also searched hard copies of relevant journals and conference proceedings for libraries we had access to. Two reviewers selected qualified trials independently according to the same criteria. Disagreements were resolved by discussion and third part consultation. Then,Meta-analysis was performed using RevMan 5.3 software. Results Twenty-three trials involving 1082 patients were included in this meta analysis. The results show that compared with the control group, Dex reduced the levels of TNF-α, IL-6, and IL-8 after 30 min and 60 min one lung ventilation, while improved PaO2/FiO2 after one lung ventilation. Conclusions Dex can effectively alleviate the inflammatory response and improve oxygenation during the perioperative period in patients with one lung ventilation.