右美托咪定对小儿(腺)扁桃体切除术后苏醒期躁动影响的Meta分析

Meta-analysis of the effect of dexmedetomidine on emergence agitation in pediatric tonsillectomy with or without adenoidectomy

目的系统评价右美托咪定对小儿(腺)扁桃体切除术后苏醒期躁动的影响。方法计算机检索PubMed、EMBASE、The Cochrane Library数据库,检索时限为建库至2019年8月。纳入右美托咪定干预小儿扁桃体伴或不伴腺样体切除术后苏醒期躁动的随机对照研究(RCT),并提取以下信息:苏醒期躁动和严重躁动发生率、术后阿片类镇痛药物使用率、拔管时间、不良反应(心动过缓、恶心呕吐、严重咳嗽及喉痉挛等),采用Cochrane协作网系统评价法评价文献质量,采用RevMan 5.3软件行Meta分析。结果共纳入14项RCT研究,1504例患儿。与对照组(安慰剂或阿片类药物)相比,右美托咪定组苏醒期躁动、严重躁动发生率及术后阿片类镇痛药物使用率降低(P<0.05)。针对不同给药剂量行亚组分析,右美托咪定<1μg/kg组拔管时间延长(P<0.05),右美托咪定≥1μg/kg组拔管时间差异无统计学意义(P>0.05)。右美托咪定组心动过缓、恶心呕吐发生率差异无统计学意义(P>0.05),咳嗽、气道痉挛发生率降低(P<0.05)。结论右美托咪定可降低小儿(腺)扁桃体切除术后苏醒期躁动的发生,提高苏醒质量。

Objective To systematically evaluate the effect of dexmedetomidine on emergence agitation after tonsillectomy with or without adenoidectomy in children.MethodsThree databases(PubMed,EMBASE,The Cochrane Library)were searched for RCT studies involving the intervention effect of dexmedetomidine on emergence agitation in pediatric tonsillectomy with or without adenoidectomy from the start of their database to August 2019.The following information was extracted from the included studies:the incidence of emergence agitation and severe agitation,the rescue opioid analgesics consumption,tracheal extubation time,and the occurrence of adverse reactions(including bradycardia,nausea and vomiting,severe cough and laryngeal spasm,etc).The quality of the studies was evaluated by the the Cochrane collaboration.Meta analysis was conducted by RevMan 5.3 software.ResultsA total of 14 randomized controlled studies were included with 1504 children.Compared with the control group(placebos or opioids),the incidence of emergence agitation,severe emergence agitation and the rescue opioid analgesics in the dexmedetomidine group were significantly decreased(P<0.05).Subgroup analysis was performed for different doses of dexmedetomidine.The extubation time was prolonged in the subgroup with dexmedetomidine<1μg/kg(P<0.05),while the extubation time in the subgroup with dexmedetomidine≥1μg/kg had no statistically difference(P>0.05).No significant change was found in the incidence of bradycardia,nausea and vomiting(P>0.05).While,the incidence of cough and airwayspasm in the dexmetotomidine group was lower(P<0.05).ConclusionDexmedetomidine can reduce the occurrence of emergence agitation and improve the quality of recovery after tonsillectomy with or without adenoidectomy in children.