右美托咪定对椎管内麻醉易化作用的Meta分析

The facilitation of Dexmedetomidine on the spinal anesthesia: A Meta-Analysis

目的通过Meta分析的方法探讨静脉输注右美托咪定(Dexmedetomidine,Dex)对椎管内麻醉效果的影响。方法计算机检索Cochrane、Pub Med、Medline、中国知网、万方数据库,检索时限均为建库至2017年4月,对符合纳入与排除标准的研究进行资料提取,并采用Rev Man5.3软件进行Meta分析。结果抽取19个高品质的随机对照试验进行分析,共计1 134例患者。Meta分析结果显示:右美托咪定组的感觉阻滞起效时间明显短于对照组[MD(95%CI):-1.08(-1.72^-0.45),P=0.000 8];右美托咪定组的感觉阻滞从最高平面消退2个平面[MD(95%CI):41.33(36.47~46.19),P=0.006]及消退至S1平面[MD(95%CI):73.82(43.51~104.12),P<0.000 01]的时间长于对照组;右美托咪定组的运动阻滞消退至Bromage 0分[MD(95%CI):59.04(50.02~68.05),P<0.00001]及Bromage 1分[MD(95%CI):15.95(8.44~23.46),P<0.000 1]的时间均长于对照组;右美托咪定组的首次要求术后镇痛的时间明显晚于对照组[MD(95%CI):108.64(102.33~114.94),P<0.000 01]。结论静脉输注右美托咪定辅助椎管内麻醉可缩短麻醉药起效时间且延迟患者术后首次要求镇痛的时间,并显著延长椎管内麻醉感觉阻滞和运动阻滞的持续时间。

Objective To evaluate the facilitation of intravenous Dexmedetomidine on the spinal anesthesia by Meta-analysis.Methods By screening the Cochrane,PubMed,Medline,CNKI and Wan Fang data,all from library to literature published till to April 2017,and data were extracted in accordance with inclusion and exclusion criteria,and Meta-analysis was performed using RevMan5.3 software.Results A total of 1 134 patients were analyzed,and 19 intermediate quality randomized controlled trials were analyzed.The results of Meta-analysis showed that the onset time of sensory block in Dexmedetomidine group was significantly shorter than the control group[MD(95%CI):-1.08(-1.72,-0.45),P=0.000 8];The two segment regression of sensory block[MD(95%CI):41.33(36.47,46.19),P=0.006]and sensory regression to S1 segment[MD(95%CI):73.82(43.51,104.12),P<0.000 01]to the time from the highest level in Dexmedetomidine group is longer than the control group;the motor block regression to Bromage scale 0[MD(95%CI):59.04(50.02,68.05),P<0.000 01]and motor block regression to Bromage scale 1[MD(95%CI):15.95(8.44,23.46),P<0.000 1]in Dexmedetomidine group is longer than that of the control group;The time of first request of analgesic in Dexmedetomidine group was significantly longer than the control group[MD(95%CI):108.64(102.33,114.94),P<0.000 01].Conclusion Intravenous Dexmedetomidine can significantly shorten the onset time of sensory block,delay the duration of sensory and motor block of spinal anesthesia,and prolong the postoperative analgesia time.