右美托咪定用于正颌手术控制性降压效果的系统评价

Efficacy of dexmedetomidine for controlled hypotension in orthognathic surgery:a systematic review

目的系统评价右美托咪定用于正颌手术控制性降压的效果。方法计算机检索PubMed、Embase、Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集右美托咪定用于正颌手术控制性降压的随机对照试验(randomized controlled trial,RCT),检索时限均从建库至2024年5月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入8个RCT,包括371例患者。Meta分析结果显示:右美托咪定组手术时间与降压药组差异无统计学意义,但比生理盐水组更少[MD=−23.20,95%CI(−44.05,−2.35),P=0.03],差异有统计学意义。右美托咪定组行控制性降压期间平均动脉压和术中出血量与对照组的差异无统计学意义。右美托咪定组控制性降压期间心率[MD=−18.78,95%CI(−30.80,−6.77),P=0.002]和术后不良反应发生率[OR=0.25,95%CI(0.08,0.76),P=0.01]均低于对照组,差异有统计学意义。结论当前证据显示,右美托咪定可有效用于正颌手术控制性降压。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of dexmedetomidine for controlled hypotension in orthognathic surgery.Methods The PubMed,Embase,Cochrane Library,CNKI,VIP and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs)on dexmedetomidine for controlled hypotension in orthognathic surgery from inception to May,2024.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was then performed by using RevMan 5.4 software.Results A total of 8 RCTs involving 371 patients were included.The results of meta-analysis showed that the operation time of dexmedetomidine group was not significantly different from that of hypotensive drug group,but was shorter than that of saline group(MD=−23.20,95%CI−44.05 to−2.35,P=0.03).There were no statistically significant differences in the mean arterial pressure and the intraoperative blood loss between dexmedetomidine group and the control group.Compared with those in the control group,the heart rate(MD=−18.78,95%CI−30.80 to−6.77,P=0.002)and the incidence of postoperative adverse events(OR=0.25,95%CI 0.08 to 0.76,P=0.01)in dexmedetomidine group were less than those in the control group significantly.Conclusion Current evidence shows that dexmedetomidine can be used effectively for controlled hypotension in orthognathic surgery.Due to the limited quality and quantity of the included studies,more high-quality studies are needed to verify above conclusion.