右美托咪定滴鼻与咪达唑仑口服用于小儿术前用药效果的比较:meta分析

Efficacy of intranasal dexmedetomidine versus oral midazolam for premedication in pediatric patients:a meta-analysis

目的采用meta分析比较右美托咪定滴鼻与咪达唑仑口服用于小儿术前用药的效果。方法检索PubMed、EMbase和Cochrane Library,纳入比较右美托咪定滴鼻与咪达唑仑口服用于患儿术前给药效果的临床随机对照试验,检索时间为从建库到2019年8月,均为英文文献。评价指标包括:术前镇静效果、麻醉面罩接受度、术后镇痛补救率、苏醒期躁动发生率及术后恢复时间。按照Cochrane系统评价员手册(Version 5.0.1)标准评价纳入文献质量,采用RevMan 5.3软件进行meta分析。结果共纳入10项研究,包括720例患儿。与咪达唑仑口服组比较,右美托咪定滴鼻组术前镇静效果更佳,术后补救镇痛率降低(P<0.01),麻醉面罩接受度、苏醒期躁动发生率和术后恢复时间差异无统计学意义(P>0.05)。结论相对于咪达唑仑口服而言,右美托咪定滴鼻用于患儿术前用药的效果更佳。

Objective To systematically review and compare the efficacy of intranasal dexmedetomidine versus oral midazolam for premedication in the pediatric patients.Methods PubMed,EMbase and Cochrane library were searched for all randomized controlled trials involving the efficacy of intranasal dexmedetomidine versus oral midazolam for premedication in the pediatric patients from inception to August 2019,with an English language restriction.Evaluation indexes included efficacy of preoperative sedation,acceptance of face mask for anesthesia,postoperative requirement for rescue analgesia,incidence of agitation during emergence and postoperative recovery time.The quality of the included trials was assessed according to the relevant criteria recommended in Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1.Meta-analysis was conducted using the Cochrane Collaboration′s Review Manager 5.3 software.Results Ten randomized controlled trials involving 720 pediatric patients were included.Compared with oral midazolam group,the efficacy of preoperative sedation was better,the requirement for postoperative rescue analgesia was decreased(P<0.01),and no significant differences were found in acceptance of face mask for anesthesia,incidence of agitation during emergence,and postoperative recovery time in intranasal dexmedetomidine group(P>0.05).Conclusion Intranasal dexmedetomidine provides better efficacy than oral midazolam when used for premedication in the pediatric patients.