【罂粟摘要】右美托咪定对患者在麻醉后恢复室滞留时间和恢复的影响：一项系统性评价和meta分析

右美托咪定对患者在麻醉后恢复室滞留时间和恢复的影响：一项系统性评价和meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：宋雨婷

编辑：马艳燕

审校：曹莹

背景  

目前关于右美托咪定在术后早期恢复中的作用证据有限。我们进行了一项系统性评价，以评估右美托咪定对患者入麻醉后恢复室（PACU）滞留时间（LOS）和恢复情况的影响。

方法

该研究方案已在国际前瞻性系统评价登记册中进行登记（PROSPERO；CRD42021240559）。无特定的资金和资助。截至 2021 年 3 月 31 日，我们在 MEDLINE、Embase、PubMed 和 Cochrane进行了检索，以查找同行评审的随机对照研究，研究对象为全麻下行非心脏、非神经外科手术且接受静脉注射右美托咪定或安慰剂的成年患者。主要结局指标为所有报道过的与麻醉后恢复室入室时间有关的统计数据指标。我们使用Stata 17.0对主要和次要结局指标（拔管时间，出现躁动，咳嗽，疼痛，术后恶心呕吐，寒战，残留镇静，心动过缓和低血压的例数）进行了个体随机效应meta分析。数据分别转变为连续型变量和二分类变量的均差（MD）和风险比（RR）。使用修订后的Cochrane随机对照试验偏倚风险评价工具（RoB 2）和评估、发展和评价建议的分级（GRADE）方法评估证据质量。

结果   

包含2676名患者在内的33项研究符合分析条件。所有研究都具有低风险或总体偏倚干扰，并为所有研究结局指标提供了从低到高的确定性证据。右美托咪定与 PACU LOS 显著增加无关（MD，0.69 分钟，95% 置信区间 [CI]，−1.42 至 2.81 分钟），与拔管时间延长有关（MD，1分钟;95%CI，0.32-1.68分钟）。右美托咪定与患者在PACU中出现躁动（RR，0.38; 95% CI，0.29–0.52）、咳嗽 （RR， 0.69; 95% CI， 0.61–0.79）、疼痛（RR， 0.50; 95% CI， 0.32–0.80）、术后恶心呕吐（RR， 0.54; 95% CI， 0.33–0.86） 和寒战（RR， 0.24; 95% CI， 0.12–0.49）的发生率显著降低有关。右美托咪定组的低血压（RR，5.39; 95% CI，1.12–5.89）发生率增加，但残余镇静（RR，1.23; 95% CI，0.20–7.56）或心动过缓（RR， 5.13; 95% CI， 0.96–27.47）的发生率没有增加。

结论

使用右美托咪定不会增加患者在PACU的滞留时间，但与患者在PACU中出现躁动、咳嗽、疼痛、术后恶心呕吐以及寒战的减少有关。患者在PACU中低血压的发生率增加，但残留镇静或心动过缓的发生率没有增加。

原始文献来源

Sin, Jeremy Cheuk Kin; Tabah, Alexis; Campher, Matthys J. J, et al. The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis. Anesthesia & Analgesia: June 2022 - Volume 134 - Issue 6 - p 1229-1244 

The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis

Background Current evidence on the effect of dexmedetomidine in early postoperative recovery is limited. We conducted a systematic review to evaluate the effect of dexmedetomidine on the length of stay (LOS) and recovery profile in postanesthesia care unit (PACU) patients.

Methods The study protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42021240559). No specific funding or support was received. We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library to March 31, 2021 for peer-reviewed randomized controlled studies comparing adult patients who received intravenous dexmedetomidine and placebo undergoing noncardiac, nonneurosurgical procedures under general anesthesia. All studies reporting statistics relating to the duration of stay in the recovery ward or PACU, the primary outcome, were included. We performed individual random-effect meta-analysis on the primary and secondary outcomes (time to extubation, emergence agitation, cough, pain, postoperative nausea and vomiting, shivering, residual sedation, bradycardia, and hypotension) using Stata version 17.0. Evidence was synthesized as mean difference (MD) and risk ratio (RR) for continuous and dichotomous variables, respectively. The quality of evidence was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results Thirty-three studies including 2676 patients were eligible for analysis. All studies had low risk or some concerns of overall bias and provided low-to-high certainty evidence for all studied outcomes. Dexmedetomidine was not associated with a significantly increased PACU LOS (MD, 0.69 minute; 95% confidence interval [CI], −1.42 to 2.81 minutes). It was associated with a statistically but not clinically significant prolonged time to extubation (MD, 1 minute; 95% CI, 0.32–1.68 minutes). Dexmedetomidine was associated with significantly reduced incidence of emergence agitation (RR, 0.38; 95% CI, 0.29–0.52), cough (RR, 0.69; 95% CI, 0.61–0.79), pain (RR, 0.50; 95% CI, 0.32–0.80), postoperative nausea and vomiting (RR, 0.54; 95% CI, 0.33–0.86), and shivering (RR, 0.24; 95% CI, 0.12–0.49) in PACU. There was an increased incidence of hypotension (RR, 5.39; 95% CI, 1.12–5.89) but not residual sedation (RR, 1.23; 95% CI, 0.20–7.56) or bradycardia (RR, 5.13; 95% CI, 0.96–27.47) in the dexmedetomidine group.

Conclusions The use of dexmedetomidine did not increase the duration of PACU LOS but was associated with reduced emergence agitation, cough, pain, postoperative nausea and vomiting, and shivering in PACU. There was an increased incidence of hypotension but not residual sedation or bradycardia in PACU.

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