右美托咪定对小儿七氟醚全麻恢复期间影响的Meta分析_《中国循证医学杂志》

作者：

陈凤收 ,  马虹

中国医科大学附属第一医院麻醉科（沈阳 110001）;

关键词：

右美托咪定儿童七氟醚全身麻醉麻醉恢复 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130102

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价右美托咪定对小儿七氟醚全麻恢复期间的影响。
方法　计算机检索 PubMed（1966～2012.3）、The Cochrane Library（2012年第1期）、EBSCO（ASP）（1984～2012.3）、Journals@Ovid Full Text（1993～2012.3）、CBM（1978～2012.3）、CNKI（1979～2012.3）、VIP（1989～2012.3）和WanFang Data（1998～2012.3），同时检索纳入文献的参考文献，纳入探讨右美托咪定对小儿七氟醚全麻恢复期间影响的随机对照试验（RCT）。由两位研究者独立进行资料提取和纳入研究的方法学质量评价后，采用RevMan5.2软件进行Meta分析。
结果　纳入16个RCT，共1 217例患者。Meta 分析结果显示：与安慰剂相比，右美托咪定能降低小儿七氟醚全麻恢复期间躁动的发生［OR=0.18，95%CI（0.13，0.25），P lt;0.000 01］，增加术后嗜睡的发生［OR=0.14，95%CI（0.03，0.68），P=0.01］，但其他不良反应（包括支气管痉挛、呛咳、屏气、血氧饱和度下降）的发生情况两组无差异，右美托咪定也能降低麻醉恢复期间小儿的平均动脉压和心率。但应用右美托咪定会延长小儿七氟醚麻醉的苏醒时间［MD=2.14，95%CI（0.95，3.33），P=0.000 4］、拔管（或移除喉罩）时间［MD=1.26，95%CI（0.51，2.00），P=0.000 9］及PACU停留时间［MD=4.72，95%（2.07，7.38），P=0.000 5］。
结论　右美托咪定能降低小儿七氟醚全麻恢复期间躁动的发生率，且有利于维持麻醉恢复期间血流动力学的稳定，但会延长全麻后苏醒时间、拔管（或移除喉罩）时间、PACU停留时间，也会增加术后嗜睡的发生率。

引用本文： 陈凤收,马虹. 右美托咪定对小儿七氟醚全麻恢复期间影响的Meta分析. 中国循证医学杂志, 2013, 13(5): 580-587. doi: 10.7507/1672-2531.20130102 复制

1.	Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in paediatric-aged patients. Paediatr Anaesth, 2002, 12(2): 171-175.
2.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
3.	Ibacache ME, Muñoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg, 2004, 98(1): 60-63.
4.	Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
5.	Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6.	Erdil F, Demirbilek S, Begec Z, et al. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anaesth Intensive Care, 2009, 37(4): 571-576.
7.	Sato M, Shirakami G, Tazuke-Nishimura M, et al. Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery. J Anesth, 2010, 24(5): 675-682.
8.	Al-Zaben KR, Qudaisat IY, Al-Ghanem SM, et al. Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery. Eur J Anaesthesiol, 2010, 27(3): 247-252.
9.	张加强, 孟凡民, 侯艳华, 等. 右旋美托咪啶对小儿七氟醚麻醉苏醒期躁动及血流动力学的影响. 临床麻醉学杂志, 2010, 26(7): 627-628.
10.	房洁渝, 肖亮灿, 郭隽英, 等. 右美托咪啶预防儿童全身麻醉后躁动的临床研究. 中国医药指南, 2010, 37(7): 121-122.
11.	Özcengiz D, Gunes Y, Ozmete O. Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children. J Anesth, 2011, 25(2): 184-188.
12.	甘秀峰, 陈彦青, 邹聪华. 右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响. 中华麻醉学杂志, 2011, 31(2): 166-167.
13.	金约西, 李军. 右美托咪啶用于小儿全麻苏醒期躁动的临床观察. 中国医院药学杂志, 2011, 31(13): 1117-1120.
14.	薛涛, 孙红梅, 孙剑. 右美托咪啶减轻小儿全身麻醉术后躁动的临床观察. 山西医药杂志, 2011, 40(8): 783-784.
15.	黄毓婵, 房洁瑜, 朱琼芳. 右美托咪啶预防儿童术后躁动的观察及护理.临床护理杂志, 2011, 10(5): 51-53.
16.	朱琼芳, 房洁渝, 陈旭素. 全麻诱导前应用右美托咪啶对腺样体切除术儿童苏醒期应激反应的影响. 中山大学学报(医学科学版), 2011, 32(6): 803-806.
17.	Lili X, Jianjun S, Haiyan Z. The application of dexmedetomidine in children undergoing vitreoretinal surgery. J Anesth, 2012, 26(4): 556-561.
18.	刘建平. 系统评价. 见: 梁万年, 主编. 医学科研方法学. 第1版. 北京: 人民卫生出版社, 2002: 451-486.
19.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
20.	Szumita PM, Baroletti SA, Anger KE, et al. Sedation and analgesia in the intensive care unit evaluating the role of dexmedetomidine. Am J Health Syst Pharm, 2007, 64(1): 37-44.
21.	Tobias JD. Dexmedetomidine applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med, 2007, 8(2): 115-131.
22.	赵博, 马虹. 右旋美托咪啶用于椎管内麻醉随机对照试验的Meta分析. 中国循证医学杂志, 2011, 11(12): 1419-1426.
23.	Keaney A, Diviney D, Harte S, et al. Postoperative behavioral changes following anesthesia with sevoflurane. Paediatr Anaesth, 2004, 14(10): 866-870.
24.	Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
25.	Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: acomparison with halothane. Paediatr Anaesth, 2000, 10(4): 419-424.
26.	Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg, 2007, 104(1): 84-91.
27.	Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg, 2003, 96(6): 1625-1630.

1. Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in paediatric-aged patients. Paediatr Anaesth, 2002, 12(2): 171-175.
2. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth, 2005, 15(9): 762-766.
3. Ibacache ME, Muñoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg, 2004, 98(1): 60-63.
4. Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth, 2005, 15(12): 1098-1104.
5. Isik B, Arslan M, Tunga AD, et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth, 2006, 16(7): 748-753.
6. Erdil F, Demirbilek S, Begec Z, et al. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anaesth Intensive Care, 2009, 37(4): 571-576.
7. Sato M, Shirakami G, Tazuke-Nishimura M, et al. Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery. J Anesth, 2010, 24(5): 675-682.
8. Al-Zaben KR, Qudaisat IY, Al-Ghanem SM, et al. Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery. Eur J Anaesthesiol, 2010, 27(3): 247-252.
9. 张加强, 孟凡民, 侯艳华, 等. 右旋美托咪啶对小儿七氟醚麻醉苏醒期躁动及血流动力学的影响. 临床麻醉学杂志, 2010, 26(7): 627-628.
10. 房洁渝, 肖亮灿, 郭隽英, 等. 右美托咪啶预防儿童全身麻醉后躁动的临床研究. 中国医药指南, 2010, 37(7): 121-122.
11. Özcengiz D, Gunes Y, Ozmete O. Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children. J Anesth, 2011, 25(2): 184-188.
12. 甘秀峰, 陈彦青, 邹聪华. 右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响. 中华麻醉学杂志, 2011, 31(2): 166-167.
13. 金约西, 李军. 右美托咪啶用于小儿全麻苏醒期躁动的临床观察. 中国医院药学杂志, 2011, 31(13): 1117-1120.
14. 薛涛, 孙红梅, 孙剑. 右美托咪啶减轻小儿全身麻醉术后躁动的临床观察. 山西医药杂志, 2011, 40(8): 783-784.
15. 黄毓婵, 房洁瑜, 朱琼芳. 右美托咪啶预防儿童术后躁动的观察及护理.临床护理杂志, 2011, 10(5): 51-53.
16. 朱琼芳, 房洁渝, 陈旭素. 全麻诱导前应用右美托咪啶对腺样体切除术儿童苏醒期应激反应的影响. 中山大学学报(医学科学版), 2011, 32(6): 803-806.
17. Lili X, Jianjun S, Haiyan Z. The application of dexmedetomidine in children undergoing vitreoretinal surgery. J Anesth, 2012, 26(4): 556-561.
18. 刘建平. 系统评价. 见: 梁万年, 主编. 医学科研方法学. 第1版. 北京: 人民卫生出版社, 2002: 451-486.
19. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
20. Szumita PM, Baroletti SA, Anger KE, et al. Sedation and analgesia in the intensive care unit evaluating the role of dexmedetomidine. Am J Health Syst Pharm, 2007, 64(1): 37-44.
21. Tobias JD. Dexmedetomidine applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med, 2007, 8(2): 115-131.
22. 赵博, 马虹. 右旋美托咪啶用于椎管内麻醉随机对照试验的Meta分析. 中国循证医学杂志, 2011, 11(12): 1419-1426.
23. Keaney A, Diviney D, Harte S, et al. Postoperative behavioral changes following anesthesia with sevoflurane. Paediatr Anaesth, 2004, 14(10): 866-870.
24. Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
25. Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: acomparison with halothane. Paediatr Anaesth, 2000, 10(4): 419-424.
26. Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg, 2007, 104(1): 84-91.
27. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg, 2003, 96(6): 1625-1630.

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《中国循证医学杂志》

右美托咪定对小儿七氟醚全麻恢复期间影响的Meta分析

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《中国循证医学杂志》

右美托咪定对小儿七氟醚全麻恢复期间影响的Meta分析

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