鼻内给予右美托咪定对比口服水合氯醛用于儿童程序化镇静有效性和安全性的Meta分析

Meta-analysis of Efficacy and Safety of Intranasal Administration of Dexmedetomidine versus Oral Administration of Chloral Hydrate for Programmed Sedation in Children

目的:系统评价鼻内给予右美托咪定对比口服水合氯醛用于儿童程序化镇静的有效性和安全性。方法:计算机检索Cochrane图书馆、PubMed、Embase、中国生物医学文献数据库、中国知网数据库和万方数据库,收集鼻内给予右美托咪定(试验组)对比口服水合氯醛(对照组)用于儿童程序化镇静的随机对照试验(RCT)。筛选文献、提取资料后采用Cochrane 5.1.0偏倚风险评估工具对纳入文献质量进行评价,采用Rev Man 5.3软件进行Meta分析。结果:共纳入8项RCT,共计1413例患儿。Meta分析结果显示,试验组患儿镇静成功率[RR=1.13,95%CI(1.02,1.25),P=0.02]、镇静起效时间[MD=-1.07,95%CI(-1.82,-0.31),P=0.006]、镇静持续时间[MD=-8.25,95%CI(-14.02,-2.47),P=0.005]、苏醒时间[MD=-9.63,95%CI(-15.40,-3.86),P=0.001]、恶心呕吐发生率[RR=0.05,95%CI(0.02,0.14),P<0.00001]均显著优于对照组;两组患儿血氧饱和度<95%发生率[RR=0.60,95%CI(0.24,1.54),P=0.29]、低血压发生率[RR=1.18,95%CI(0.51,2.74),P=0.71]、心动过缓发生率[RR=1.33,95%CI(0.18,9.88),P=0.78]比较,差异均无统计学意义。结论:鼻内给予右美托咪定相较于口服水合氯醛用于儿童程序化镇静的效果更优,且安全性较好。

OBJECTIVE:To systematically evaluate the efficacy and safety of intranasal administration of dexmedetomidine versus oral administration of chloral hydrate for programmed sedation in children.METHODS:Retrieved from Cochrane Library,PubMed,Embase,CBM,CNKI and Wanfang database,randomized controlled trials(RCTs)about intranasal administration of dexmedetomidine(trial group)versus oral administration of chloral hydrate(control group)for programmed sedation in children were collected.Cochrane 5.1.0 bias risk assessment tool was used to evaluate the quality of the included literatures after literature screening and data extraction,and Meta-analysis was conducted by using Rev Man 5.3 statistical software.RESULTS:A total of 8 RCTs were included,with a total of 1413 children.Meta-analysis showed that the sedation success rate[RR=1.13,95%CI(1.02,1.25),P=0.02],sedation onset time[MD=-1.07,95%CI(-1.82,-0.31),P=0.006],sedation duration[MD=-8.25,95%CI(-14.02,-2.47),P=0.005],wake-up time[MD=-9.63,95%CI(-15.40,-3.86),P=0.001],the incidence of nausea and vomiting[RR=0.05,95%CI(0.02,0.14),P<0.00001]in the trial group were significantly better than those in control group.There was no statistical significance in the incidence of SpO2<95%[RR=0.60,95%CI(0.24,1.54),P=0.29],incidence of hypotension[RR=1.18,95%CI(0.51,2.74),P=0.71],incidence of bradycardia[RR=1.33,95%CI(0.18,9.88),P=0.78]between 2 groups.CONCLUSIONS:Intranasal administration of dexmedetomidine has better efficacy than oral administration of chloral hydrate for programmed sedation in children with good safety.