减少气管插管全身麻醉后咳嗽的药物:系统回顾与meta分析

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Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis

背景与目的

手术结束时出现呛咳可能会对患者造成伤害，但哪种药物可最有效地减少这种情况发生，目前尚不清楚。我们对随机对照试验进行了系统回顾和网络 meta分析，以明确药物减少全身麻醉后中重度呛咳的相对疗效。所研究的药物为利多卡因（静脉注射、套囊涂抹、局部或气管内使用）、右美托咪定、瑞芬太尼和芬太尼。

方  法

我们搜索了八个不同的医学文献数据库、会议摘要和文章参考。筛选后，对收录文献进行偏倚评估并提取数据。计算各药物处理组比较的合并优势比和95%可信区间。累积排名曲线分析（SUCRA）的面积可确定减少中重度呛咳的每种干预措施的相对排名。亚组分析包括严重咳嗽、拔管时间、麻醉维持类型和剂量。

结 果  

网络 meta分析共收集了70项研究和5286例患者。与不使用药物或安慰剂相比，所有研究药物在减轻中重度拔管期呛咳方面都有良好效果。单一药物的效果并未较其它药物更为显著。右美托咪定的SUCRA排名最高，其次是瑞芬太尼、芬太尼和利多卡因(套囊涂抹、气管内/局部使用、静脉注射)。瑞芬太尼在减轻严重咳嗽方面排名最高。与安慰剂、右美托咪定、芬太尼和瑞芬太尼相比，套囊涂抹利多卡因延长拔管时间的几率更高。

结 论

所有研究药物在缓解中重度呛咳方面均优于安慰剂或无药物处理组，其中以右美托咪定最有效。

原始文献来源及摘要

Tung A, Fergusson NA, Ng N, et al. Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis.[J]. Br J Anaesth 2020 Feb 22.

Background: Emergence coughing can harm the patient following completion of surgery, but it is unclear which medication is most effective at reducing this event. We conducted a systematic review and network meta-analysis of RCTs to determine the medications’ relative efficacies on decreasing moderate to severe emergence coughing after general anaesthesia. Medications studied were lidocaine (i.v., intracuff, topical, or tracheal application), dexmedetomidine, remifentanil, and fentanyl.

Methods: We searched eight different medical literature databases, conference abstracts, and article references. After screening, included citations were evaluated for bias and had their data extracted. Pooled odds ratios and 95% confidence intervals for each treatment comparison were calculated. A surface under the cumulative ranking curve analysis (SUCRA) determined the relative rank of each intervention to decrease moderate to severe emergence coughing. Subgroup analyses included severe coughing only, extubation times, type of maintenance anaesthetic, and dosages.

Results: The network meta-analysis included 70 studies and 5286 patients. All study medications had favourable odds in reducing moderate and severe peri-extubation coughing compared with either no medication or placebo. No single medication was favoured over another. Dexmedetomidine had the highest SUCRA rank, followed in order by remifentanil, fentanyl, and lidocaine via intracuff, tracheal/topical, and i.v. routes. Remifentanil was ranked highest for decreasing severe coughing only. Intracuff lidocaine had higher odds of prolonging extubation times compared with placebo, dexmedetomidine, fentanyl, and remifentanil.

Conclusion: All study medications were better than placebo or no medication in reducing moderate to severe emergence cough, with dexmedetomidine ranked the most effective.

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