Chinese Medical Sciences Journal ›› 2023, Vol. 38 ›› Issue (1): 1-10.doi: 10.24920/004088
• 论著 • 下一篇
收稿日期:
2022-03-21
接受日期:
2022-07-27
出版日期:
2023-03-31
发布日期:
2022-09-19
通讯作者:
田丽娟
E-mail:tlijuan1982@163.com
Li-Juan Tian1,*(),Yun-Tai Yao1,Su Yuan1,Zheng Dai2
Received:
2022-03-21
Accepted:
2022-07-27
Published:
2023-03-31
Online:
2022-09-19
Contact:
Li-Juan Tian
E-mail:tlijuan1982@163.com
摘要:
目的 右美托咪定(dexmedetomidine)作为一种高选择性α2肾上腺素受体激动剂,具有镇静、镇痛、无呼吸抑制作用,广泛用于围手术期麻醉。本研究采用Meta分析方法评估右美托咪定对老年患者围手术期血流动力学稳定性的影响。
方法 利用PubMed、EMBASE、Ovid、Cochrane图书馆、中国知网和万方数据库检索截至2021年9月关于右美托咪定对老年患者围手术期血流动力学稳定性影响随机对照试验的相关文献。采用标准加权均数差(standardized mean differences, SMD)作为效应量 ,以各效应量及其95%可信区间(confidence interval, CI)进行结果分析。由于各研究间存在异质性,采用随机效应模型分析。
结果 共纳入12项随机对照试验研究,共833例老年患者(右美托咪定组患者546例;对照组患者287例)。Meta分析结果显示,与术前比较,右美托咪定组老年患者术中心率(heart rate, HR)、平均动脉压(mean arterial pressure,MAP)和舒张压(diastolic blood pressure,DBP)均无明显升高。与对照组比,右美托咪定组老年患者的HR、MAP、收缩压(systolic blood pressure,SBP)和DBP等血流动力学指标的变化显著降低(HR:SMD = -0.87,95% CI:-1.13 ~ -0.62;MAP:SMD = -1.12, 95% CI:-1.60 ~ -0.63;SBP:SMD = -1.27,95% CI:-2.26 ~-0.27;DBP:SMD = -0.96,95% CI:-1.33 ~ -0.59)。亚组分析表明给予1.0 μg/kg 右美托咪定治疗,患者心率呈现时间相关进行性下降。
结论 右美托咪定可维持老年患者围手术期血流动力学更稳定。然而,关于右美托咪定在老年患者应用的有效性和安全剂量尚需开展高质量研究予以验证。
Li-Juan Tian, Yun-Tai Yao, Su Yuan, Zheng Dai. Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis[J].Chinese Medical Sciences Journal, 2023, 38(1): 1-10.
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Author, year | Sample size | Dexmedetomidine dose/administration | Control group | Surgery | |
---|---|---|---|---|---|
Dex | Con | ||||
Qiao, 2020[ | 50 | 50 | 0.40 μg/kg loading | Blank | Undergoing laparoscopic cholecystectomy |
Li, 2015[ | 20 | 20 | 1.00 μg/kg loading | Blank | ERCP |
Song, 2017[ | 30 | 30 | 1.00 μg/kg loading | Blank | Undergoing tracheal intubation under general anesthesia |
Chen, 2019[ | 90 | 30 | 0.20, 0.40, 0.60 μg/kg/h infusion | Saline | Colorectal cancer surgery |
Lin, 2017[ | 44 | 22 | 0.50, 1.00 μg/kg loading; 0.50 μg/kg/h infusion | Blank | Radical resection of esophageal carcinoma under thoracoscopy surgery |
Su, 2014[ | 25 | 25 | 0.50 μg/kg loading; 0.40 μg/kg/h infusion | Saline | Thoracolumbar surgery |
Zhang, 2018[ | 30 | 30 | 0.50 μg/kg loading | Saline | Abdominal operation |
Cao, 2018[ | 90 | 0 | 0.30, 0.50, 0.70 μg/kg loading | Blank | Radical resection of colorectal cancer |
Guan, 2015[ | 60 | 20 | 0.25, 0.50, 1.00 μg/kg loading; constant speed infusion in 10mins | Saline | Abdominal surgery |
Lee, 2017[ | 20 | 20 | 0.50 μg/kg loading; constant speed infusion in 10 min | Saline | Hypertension patients with noncardiac surgery |
Ko, 2015[ | 47 | 0 | 0.10, 0.30, 0.50, 0.70, 1.00 μg/kg loading | Blank | Orthopedic or urologic surgery |
Du, 2019[ | 40 | 40 | 0.60 μg/kg/h infusion | Saline | Laparoscopic cholecystectomy surgery |
"
Indexes | No. of studies | Sample size | SMD (95% CI) | Heterogeneity | |
---|---|---|---|---|---|
I2 (%) | P value | ||||
Comparison between before and after operation | |||||
MAP | 8 | 450 | 0.12 (-0.54, 0.79) | 93.1 | <0.001 |
HR | 10 | 550 | 0.13 (-0.44, 0.70) | 91.7 | <0.001 |
SBP | 4 | 200 | 1.38 (0.11, 2.64) | 93.5 | <0.001 |
DBP | 4 | 200 | 1.11 (-0.25, 2.46) | 94.5 | <0.001 |
Comparison between dexmedetomidine and control | |||||
MAP | 8 | 440 | -1.12 (-1.60, -0.63) | 81.6 | <0.001 |
HR | 10 | 540 | -0.87 (-1.13, -0.62) | 50.8 | 0.032 |
SBP | 4 | 200 | -1.27 (-2.26, -0.27) | 90.0 | <0.001 |
DBP | 4 | 200 | -0.96 (-1.33, -0.59) | 34.9 | 0.203 |
Time effect of SBP and HR with 0.5 μg/kg and 1.0 μg/kg dexmedetomidine, respectively | |||||
SBP(0.5, 0) | 3 | 112 | -1.17 (-3.36, 1.02) | 96.0 | <0.001 |
SBP(0.5, 10) | 3 | 112 | -0.07 (-0.43, 0.28) | 0.0 | 0.686 |
SBP(0.5, 20) | 2 | 62 | -0.59 (-1.10, -0.08) | 0.0 | 0.320 |
SBP(1, 0) | 2 | 64 | -0.24 (-0.73, 0.25) | 0.0 | 0.889 |
SBP(1, 10) | 2 | 64 | -0.86 (-1.95, 0.22) | 74.5 | 0.048 |
SBP(1, 20) | 2 | 64 | -0.24 (-0.73, 0.25) | 0.0 | 0.889 |
HR(0.5, 0) | 5 | 212 | -0.41 (-0.95, 0.13) | 72.4 | 0.006 |
HR(0.5, 10) | 5 | 212 | -0.73 (-1.51, 0.04) | 85.7 | <0.001 |
HR(0.5, 20) | 3 | 102 | -1.48 (-2.30, -0.66) | 68.5 | 0.042 |
HR(1, 0) | 2 | 64 | -0.14 (-0.63, 0.35) | 0.0 | 0.340 |
HR(1, 10) | 2 | 64 | -1.53 (-2.09, -0.97) | 0.0 | 0.709 |
HR(1, 20) | 2 | 64 | -1.96 (-2.56, -1.36) | 0.0 | 0.944 |
"
Index | Egger's regression | Duval and Tweedie's trim and fill | ||||
---|---|---|---|---|---|---|
Intercept | P value | Original OR | Studies trimmed | Adjusted OR | ||
Comparison between before and after operation | ||||||
MAP | 9.392 | 0.334 | 0.12 (-0.54, 0.79) | 2 | -0.18 (-0.84, 0.49) | |
HR | 18.491 | 0.067 | 0.13 (-0.44, 0.71) | 3 | -0.21 (-0.78, 0.36) | |
Comparison between dexmedetomidine and control (blank or saline) | ||||||
MAP | -2.395 | 0.669 | -1.12 (-1.61, -0.63) | 0 | -1.12 (-1.61, -0.63) | |
HR | 2.967 | 0.408 | -0.87 (-1.13, -0.62) | 0 | -0.87 (-1.13, -0.62) |
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