Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis

Li-Juan Tian; Yun-Tai Yao; Su Yuan; Zheng Dai

doi:10.24920/004088

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Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis

Chinese Medical Sciences Journal Vol. 38, Issue 1, Pages: 1-10(2023)

Original Article | Updated：2024-03-30

- Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis
- Affiliations：
  
  1. 1Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
  2. 2Department of Anesthesiology, Yunnan Fuwai Cardiovascular Hospital, Kunming 650102, China
- Author bio：
- Funds：
- DOI：10.24920/004088
  CLC：
- Received：21 March 2022，
  
  Accepted：2022-7-27，
  
  Published Online：19 September 2022，
  
  Published：31 March 2023
- Accepted：
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Li-Juan Tian, Yun-Tai Yao, Su Yuan, et al. 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.
DOI：

Li-Juan Tian, Yun-Tai Yao, Su Yuan, et al. 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. DOI： 10.24920/004088.

摘要

目的

右美托咪定（dexmedetomidine）作为一种高选择性α

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。

Abstract

Objective

Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.

Methods

PubMed

Web of Science

the Cochrane Library

China National Knowledge Infrastructure (CNKI)

and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September

2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.

Results

A total of 12 RCTs with 833 elderly patients (dexmedetomidine group

546 patients; control group

287 patients) were included. There was no significant increase in perioperative heart rate (HR)

mean arterial pressure (MAP)

and diastolic blood pressure (DBP) in the dexmedeto

midine group before and during the operation. In addition

the variations of hemodynamic indexes including HR

MAP

SBP (systolic blood pressure)

and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = -0.87

95%

: -1.13 to -0.62; MAP: SMD = -1.12

95%

: -1.60 to -0.63; SBP: SMD = -1.27

95%

: -2.26 to -0.27; DBP: SMD = -0.96

95%

: -1.33 to -0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion

the patient's heart rate declined in a time-dependent way.

Conclusion

Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However

further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.

关键词

Keywords

references

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