右美托咪定对缓解小儿扁桃体切除术后躁动有效性和安全性的系统评价

Efficacy and safety of dexmedetomidine in relieving agitation after tonsillectomy in children

目的系统评价右美托咪啶对缓解小儿扁桃体切除术后躁动性的有效性和安全性,为临床应用提供循证参考。方法计算机检索PubMed、Web of Science、中国知网(CNKI)、万方数据知识服务平台(WanFang)等数据库,搜索关于右美托咪啶缓解小儿扁桃体术后躁动性有效性和安全性的随机对照试验(randomized controlled trial,RCT),检索时限均从建库至2022年5月。参考Cochrane Handbook 5.1评价标准对纳入研究进行质量评估,使用RevMan 5.4软件进行Meta分析。结果共纳入24篇RCT,2085例患者。Meta分析结果显示,试验组患儿术后总躁动率[RR=0.41,95%CI(0.35~0.48),P<0.05]、躁动评分[MD=-2.76,95%CI(-3.94~-1.59),P<0.05]、不良反应发生率[RR=0.49,95%CI(0.38~0.63),P<0.05]显著小于对照组,差异有统计学意义。两组患儿术后拔管时间[MD=1.80,95%CI(-0.09~3.69),P=0.06]、苏醒时间[MD=-0.44,95%CI(-1.96~1.08),P=0.57]比较差异无统计学意义。试验组患儿术后心率[MD=-15.32,95%CI(-19.40~-11.24),P<0.05]、平均动脉压(mean artery pressure,MAP)[MD=-7.85,95%CI(-11.19~-4.51),P<0.05]显著低于对照组,差异有统计学意义。结论右美托咪啶可显著降低患儿扁桃体术后躁动率及不良反应发生率,使心率、MAP低于对照组,但有效维持血流动力学稳定,且不影响患儿术后的拔管时间和苏醒时间。

Objective To systematically evaluate the efficacy and safety of dexmedetomidine in relieving agitation after tonsillectomy in children,and to provide evidencebased reference for clinical application.Methods PubMed,Web of Science,CNKI,Wanfang and other databases were searched by computer to collect RCTs on the effectiveness and safety of dexmedetomidine in alleviating postoperative agitation in children.The retrieval time limit was from the establishment of the database to May 2022.The quality of the included studies was evaluated by referring to the Cochrane Handbook 5.1 evaluation standard,and meta-analysis was carried out by Revman 5.4 software.Results A total of 24 RCTs were included,including 2085 patients.The results of Meta-analysis showed that the total restlessness rate[RR=0.41,95%CI(0.35-0.48),P<0.05],restlessness score[MD=-2.76,95%CI(-3.94--1.59),P<0.05]and the incidence of adverse reactions[RR=0.49,95%CI(0.38-0.63),P<0.05]in the experimental group were significantly lower than those in the control group.There was no significant difference in extubation time[MD=1.80,95%CI(-0.09-3.69),P=0.06]and recovery time[MD=-0.44,95%CI(-1.96-1.08),P=0.57]between the two groups.The postoperative HR[MD=-15.32,95%CI(-19.40--11.24),P<0.05]and MAP[MD=-7.85,95%CI(-11.19--4.51),P<0.05]in the experimental group were significantly lower than those in the control group.Conclusions Dexmedetomidine can significantly reduce the restlessness rate and adverse reaction rate of children after tonsillectomy,and make HR and MAP lower than those in the control group,but it can effectively maintain hemodynamic stability,and does not affect the extubation time and recovery time of children after tonsillectomy.