盐酸右美托咪定用于膝关节镜手术患者腰硬联合麻醉效果及安全性的Meta分析

Meta analysis of efficacy and safety of dexmedetomidine hydrochloride in combined spinal epidural anesthesia in patients undergoing knee arthroscopic surgery

目的:采用Meta分析的方法评价盐酸右美托咪定用于膝关节镜手术患者腰硬联合麻醉的效果及安全性。方法:通过检索中国期刊全文数据库(CNKI)、万方数据库、中国生物医学文献服务系统(CBM)、维普中文科技期刊全文数据库、Pubmed、Embase、Cochrane图书馆外文数据库,收集盐酸右美托咪定用于膝关节镜手术患者腰硬联合麻醉中的临床随机对照试验,检索时间为建库至2018-05,采用Cochrane协作网系统评价纳入文献的质量,采用Rev Man 5.3软件进行分析。结果:共纳入10篇随机对照研究文献,共735例患者,其中右美托咪定组367例,对照组368例。Meta分析结果显示,右美托咪定组的Ramsay镇静评分(Ramsay sedation score,RSS)高于对照组(MD=3.28,95%CI:1.89～2.61,P<0.05),视觉模拟评分(visual analogue scale,VAS)(MD=-1.21,95%CI:-1.33～-1.09,P<0.05)、运动神经阻滞评分(motor block score,MBS)(MD=-1.06,95%CI:-1.12～-1.00,P<0.05)、不良反应发生率(OR=5.23,95%CI:3.06～8.96,P<0.05)均低于对照组,说明右美托咪定镇静、镇痛效果较好。结论:盐酸右美托咪定用于膝关节镜手术腰硬联合麻醉中临床疗效较为显著,安全性较高,值得临床推广应用。

Objective:To evaluate the efficacy and safety of dexmedetomidine hydrochloride in combined spinal epidural anesthesia for knee arthroscopic surgery using Meta analysis.Methods:By searching Chinese journal full-text database(CNKI),Wanfang database,China biomedical document service system(CBM),Weipu Chinese science and technology periodical full-text database,Pubmed,Embase,and Cochrane library foreign language database.Clinical randomized controlled trials were collected on dexmedetomidine hydrochloride combined spinal-epidural anesthesia for knee arthroscopic surgery.The search time was from the establishment of the database to May 2018.The quality of the literature was assessed using the Cochrane collaborative network system and Rev Man 5.3 software was used for analysis.Results:Ten studies were included,367 patients in the dexmedetomidine group and 368 patients in the control group.The results showed that the Ramsay sedation score(RSS)in dexmedetomidine group were higher than that in control group(MD=3.28,95%CI:1.89-2.61,P<0.05),visual analogue scale(VAS)score(MD=-1.21,95%CI:-1.33 to-1.09,P<0.05),motor block score(MBS)(MD=-1.06,95%CI:-1.12 to-1.00,P<0.05),adverse reactions rate(OR=5.23,95%CI:3.06-8.96,P<0.05)were lower than those in control group,which indicated that dexmedetomidin had good effect on sedation and analgesic.Conclusion:The clinical curative effect of dexmedetomidine hydrochloride in combined spinal epidural anesthesia in patients undergoing knee joint arthroplasty is more significant and safety,and it is worthy of promotion in clinical practice.