右美托咪定联合瑞芬太尼麻醉用于困难气道纤维支气管镜引导经鼻清醒气管插管疗效的meta分析

Meta-analysis of the efficacy of dexmedetomidine combined with remifentanil anesthesia for awake fiberoptic endoscope intubation in difficult airway

目的系统评价右美托咪定联合瑞芬太尼复合麻醉用于困难气道纤维支气管镜引导经鼻清醒气管插管(AFOI)的疗效。方法检索中国期刊全文数据库、维普资讯、万方数据知识服务平台、中国生物医学文献数据库、PubMed、Web of Science和Medline数据库中右美托咪定联合瑞芬太尼用于困难气道AFOI镇静效果相关的RCTs,检索时间为数据库建库至2023年5月31日,采用RevMan 5.4软件进行meta分析。结果共纳入15篇文献,涉及1157例病例。meta分析结果显示,两组在入室时(T_(0))和给药前(T_(1))时的平均动脉压(MAP)、呼吸频率(RR)、心率(HR)和脉搏血氧饱和度(SpO_(2))比较,差异均无统计学意义(P>0.05);与对照组比较,观察组MAP在给药结束时(T_(3))和插管后1 min(T_(7))时更稳定,RR在给药后10 min(T_(2))、T_(3)、插管前(T_(4))、插管时(T_(5))、插管完成时(T_(6))、T_(7)和插管后5 min(T_(8))时更稳定,HR在T_(2)~T_(4)、T_(7)~T_(8)时更稳定,SpO_(2)在T_(3)~T_(8)时更高。两组首次插管成功率和Ramsay镇静量表评分比较,差异无统计学意义(P>0.05)。观察组躁动、咳嗽和恶心发生率及插管知晓率均低于对照组,差异有统计学意义(P<0.05)。结论右美托咪定联合瑞芬太尼麻醉用于困难气道AFOI,对患者血流动力学指数影响较小,并可降低不良反应发生率和插管知晓率。

Objective To evaluate the efficacy of dexmedetomidine combined with remifentanil for anesthesia in difficult airway management using awake fiberoptic endoscope intubation(AFOI).Methods A comprehensive search was conducted in databases including CNKI,VIP,Wanfang Data,Chinese Biomedical Literature database,PubMed,Web of Science,and Medline for relevant RCTs concerning the sedative effects of dexmedetomidine and remifentanil in difficult airway AFOI,up to May 31,2023.Meta-analysis was performed using RevMan 5.4 software.Results A total of 15 articles including 1157 patients were included.The meta-analysis results showed that there were no significant differences in mean arterial pressure(MAP),respiratory rate(RR),heart rate(HR),and pulse oxygen saturation(SpO_(2)),between the two groups at the time of entering the operating room(T_(0))and before administration(T_(1))(P>0.05).Compared with the control group,the observation group showed more stable MAP at the end of administration(T_(3))and 1 min after intubation(T_(7)),more stable RR at 10 min after administration(T_(2)),T_(3),pre-intubation(T_(4)),during intubation(T_(5)),the end of intubation(T_(6)),T_(7)and 5 min post-intubation(T_(8)),more stable HR at T_(2),T_(3),T_(4),T_(7),and T_(8),and higher SpO_(2)at T_(3)to T_(8).There was no significant difference in the first-attempt intubation success rate,and Ramsay sedation scale score between the two groups(P>0.05).Compared with the control group,rates of agitation,cough,nausea and other adverse reactions,as well as awareness during intubation were significantly lower than thoes in the observation group,with statistically significant differences(P<0.05).Conclusion Dexmedetomidine combined with remifentanil anesthesia for difficult airway AFOI has less impact on patients'hemodynamic indices,and reduces the rates of adverse reactions and awareness during intubation.