静脉注射右美托咪定或咪达唑仑对蛛网膜下腔阻滞麻醉效果影响的Meta分析

Effects of Intravenous Dexmedetomidine or Midazolam on Duration of Spinal Anesthesia:A Meta-analysis

目的通过Meta分析的方法评价静脉注射右美托咪定或咪达唑仑对蛛网膜下腔阻滞麻醉效果的影响。方法系统检索Cochrane Library、PubMed、EMbase、CBM、万方、中国知网和维普数据库,检索时间为建库至2019年8月。收集比较静脉注射右美托咪定或咪达唑仑对蛛网膜下腔阻滞麻醉效果影响的临床随机对照试验,提取资料后采用RevMan 5.3软件进行统计分析。结果最终纳入10项研究,共568例患者,其中右美托咪定组283例、咪达唑仑组285例。Meta分析结果显示:右美托咪定组与咪达唑仑组的感觉阻滞起效时间比较差异无统计学意义(MD=-0.26,95%CI-0.74~0.22,P=0.28),右美托咪定组感觉阻滞下降两个平面时间、感觉阻滞下降至S_(1)所需时间长于咪达唑仑组(MD=32.50,95%CI 29.60~35.40,P<0.00001;MD=27.82,95%CI 17.95~37.69,P<0.00001);右美托咪定组运动阻滞持续时间显著长于咪达唑仑组(MD=24.41,95%CI 6.78~42.04,P=0.007);右美托咪定组术后首次要求镇痛时间明显晚于咪达唑仑组(MD=78.90,95%CI 74.61~83.18,P<0.00001),术后要求镇痛人数明显少于咪达唑仑组(OR=0.24,95%CI 0.13~0.43,P<0.00001)。不良反应方面,右美托咪定组术中心动过缓和低血压发生率明显高于咪达唑仑组(OR=3.71,95%CI 1.91~7.22,P=0.0001;OR=2.59,95%CI 1.43~4.71,P=0.002)。结论与咪达唑仑相比,静脉注射右美托咪定能明显延长蛛网膜下腔阻滞麻醉的感觉、运动阻滞时间及延迟术后首次要求镇痛时间,但有增加血流动力学波动的风险。

Objective To systematically review the effects of intravenous dexmedetomidine or midazolam on the duration of spinal anesthesia with meta-analysis.Methods We searched the PubMed,EMbase,Cochrane Library,CBM,Wanfang Database,CNKI and VIP for all randomized controlled trials(RCTs)about the effects of intravenous dexmedetomidine or midazolam in patients undergoing spinal anesthesia from the date of their establishment to Aug.2019.RevMan 5.3 software was used for meta-analysis.Results Ten RCTs involving 568 patients(dexmedetomidine groups 283 cases,midazolam groups 285 cases)were included in our meta-analysis.The results showed that the onset time of sensory block have no significant difference between the dexmedetomidine groups and the midazolam groups(MD=-0.26,95%CI-0.74-0.22,P=0.28),time for sensory block decline by two planes and time for sensory block decline to S_(1) was significantly prolonged in the dexmedetomidine groups than the midazolam groups(MD=32.50,95%CI 29.60-35.40,P<0.00001;MD=27.82,95%CI 17.95-37.69,P<0.00001).Duration of motor block was significantly prolonged in the dexmedetomidine groups(MD=24.41,95%CI 6.78-42.04,P=0.007).Longer time to first rescue analgesic request(MD=78.90,95%CI 74.61-83.18,P<0.00001)and fewer number of patients who required supplemental analgesia(OR=0.24,95%CI 0.13-0.43,P<0.00001)were seen in the dexmedetomidine groups compared with the midazolam groups.As for adverse reactions,there were higher incidence rates of bradycardia and hypotension in the dexmedetomidine groups(OR=3.71,95%CI 1.91-7.22,P=0.0001;OR=2.59,95%CI 1.43-4.71,P=0.002).Conclusion Compared with midazolam,intravenous administration of dexmedetomidine during spinal anesthesia prolongs the duration of sensory and motor blockade and provides a longer duration of postoperative analgesia.However,dexmedetomidine is associated with higher incidence of hemodynamic instability.