右美托咪定对无创机械通气患者镇静效果的Meta分析

The Sedative Effect of Dexmedetomidine on Patients with Noninvasive Mechanical Ventilation: a Meta Analysis

目的:采用系统评价的方法评价右美托咪定对无创机械通气患者镇静的效果。方法:检索Cochrane library、Pubmed、Web of science、中国生物医学数据库(CBM)、中文期刊全文数据库(CNKI)、万方数据关于右美托咪定对无创机械通气患者镇静效果的随机对照试验(RCT),检索时限从建库至2018年10月。由2位评价者按纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Rev Man5.1软件进行Meta分析。结果:共纳入11个RCT,621例患者。Meta分析结果显示:右美托咪定可以降低无创机械通气患者的谵妄发生率[OR=0.18,95%CI(0.09,0.35),P <0.000 01],气管插管率[OR=0.44,95%CI (0.28,0.7),P <0.001],无创辅助通气时间[MD=-4.80,95%CI (-6.90,-2.71),P <0.001],ICU住院时间[MD=-1.82,95%CI(-3.51,-0.14),P <0.05],8h、12h、24h Riker镇静躁动评分(SAS)[OR=0.67,95%CI(0.56,0.78)],合并效应有统计学意义。但右美托咪定副作用心动过缓发生率[OR=3.89,95%CI(0.80,18.99),P <0.09],低血压发生率[OR=0.86,95%CI(0.10,7.11),P=0.89],差异无统计学意义。结论:右美托咪定用于无创通气镇静时,可明显增强镇静水平,减少谵妄、气管插管发生率,无创通气依从性好,且发生心动过缓、低血压的副作用没有统计学意义,需临床多中心、临床随机对照试验加以验证。

Objective:To evaluate the sedative effect of dexmedetomidine on patients with noninvasive mechanical ventilation by systematic evaluation.Methods:Computer retrieval the Cochrane library,Pubmed,Web of science,Chinese biomedical database(CBM),CNKI,Wanfang data about sedative effect of Dexmedetomidine in patients with noninvasive mechanical ventilation of randomized controlled trial(RCT),from building library retrieval time until October 2018.A Meta-analysis was conducted using RevMan5.1 software after two evaluators independently screened the literature,extracted the data and evaluated the quality of the methodology included in the study according to the inclusion and exclusion criteria.Results:There were 11 RCT and 621 patients.Meta analysis showed:the right beauty microphones set which can reduce the incidence of delirium noninvasive mechanical ventilation patients(OR=0.18,95%CI(0.09,0.35),P<0.000 01),the rate of endotracheal intubation(OR=0.44,95%CI(0.28,0.28),P<0.001],noninvasive assisted ventilation time,ICU length of hospital stay,merge effect was statistically significant.The incidence of bradycardia in dexmedetomidine(OR=3.89,95%CI(0.80,18.99),P<0.09),low blood pressure incidence[OR=0.86,95%CI(0.10,7.11),P=0.89],the difference was not statistically significant.Conclusion:Right when microphones set used for noninvasive ventilation calm,can obviously enhance the level of sedation,decrease of delirium,endotracheal intubation,good adherence,noninvasive ventilation and slow heart beat(bradycardia)and ery low blood pressure effects of no statistical significance,but need more clinical multicenter,controlled clinical trial to test and verify.