右美托咪定对体外循环心脏手术后患者围术期预后影响的系统评价与Meta分析

Effect of dexmedetomidine on prognosis of patients after cardiac surgery with cardiopulmonary bypass:A systematic review and meta-analysis

目的评价右美托咪定对体外循环心脏手术后患者围术期预后的影响。方法检索PubMed、EBSCO、Web of Science、Cochrane Library、万方数据库、中国知网、中国生物医学文献数据库,每个数据库从建库至2016年12月,查找符合要求的随机对照试验,采用RevMan5.3软件进行Meta分析。结果最终共纳入16项随机对照研究,其中国外文献7篇,国内文献9篇,共1 432例患者。Meta分析结果显示,与安慰剂相比,右美托咪定能够明显降低体外循环下心脏手术后谵妄发生率[RR=0.28,95%CI(0.18,0.44),P<0.000 01]、术后心房颤动发生率[RR=0.65,95%CI(0.44,0.98),P=0.04],缩短气管插管拔管时间[RR=–1.96,95%CI(–2.07,–1.86),P<0.000 01]、住ICU时间[RR=–0.49,95%CI(–0.74,–0.24),P=0.000 1]及住院时间[RR=–1.24,95%CI(–2.26,–0.22),P=0.02]。右美托咪定组蒙特利尔认知评估量表(Mo CA)评分显著高于对照组[RR=0.88,95%CI(0.42,1.35),P=0.000 2]。结论右美托咪定可显著减少心脏手术后并发症,将其作为心脏手术患者围术期用药是安全有效的。但上述结论受纳入文献质量的限制,需要更多高质量的随机对照双盲研究,以便进一步的评价。

Objective To evaluate the clinical efficacy of dexmedetomidine in perioperative management of on-pump cardiac surgery. Methods Randomized controlled trials （RCTs） were identified through a systematic literature search of PubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database （up to December 2016）. RevMan 5.3 software was used for meta-analysis. Results Sixteen studies with 1 432 patients were included. Dexmedetomidine significantly decreased the risk of postoperative delirium （RR=0.28, 95% CI 0. 18 to 0.44, P〈0.000 01） and postoperative atrial fibrillation （RR-0.65, 95% （210.44 to 0.98, P=0.04） compared with the controls. The duration of intubation （RR=-1.96, 95% CI-2.07 to -1.86, P〈0.000 01）, length of ICU stay （RR=-0.49, 95% CI-0.74, -0.24, P=0.000 1） and hospital stay （RR=-1.24, 95% CI -2.26 to -0.22, P=0.02） in the dexmedetomidine group were significantly shorter than those of the control group. In addition, dexmedetomidine was shown to improve the score of the the Montreal Cognitive Assessment （RR=0.88, 95% CI 0.42 to 1.35, P=0.000 2） compared to the control group. Conclusion Dexmedetomidine can reduce the complications after cardiac surgery, which is safe and effective. However, more studies with good methodologic quality and large samples are still needed to make further assessment.