右美托咪定對小兒七氟醚全麻恢復期間影響的Meta分析_《中國循證醫學雜志》

作者：

陳鳳收 ,  馬虹

中國醫科大學附屬第一醫院麻醉科（沈陽 110001）;

關鍵詞：

右美托咪定兒童七氟醚全身麻醉麻醉恢復 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130102

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目的　系統評價右美托咪定對小兒七氟醚全麻恢復期間的影響。
方法　計算機檢索 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），同時檢索納入文獻的參考文獻，納入探討右美托咪定對小兒七氟醚全麻恢復期間影響的隨機對照試驗（RCT）。由兩位研究者獨立進行資料提取和納入研究的方法學質量評價后，采用RevMan5.2軟件進行Meta分析。
結果　納入16個RCT，共1 217例患者。Meta 分析結果顯示：與安慰劑相比，右美托咪定能降低小兒七氟醚全麻恢復期間躁動的發生［OR=0.18，95%CI（0.13，0.25），P lt;0.000 01］，增加術后嗜睡的發生［OR=0.14，95%CI（0.03，0.68），P=0.01］，但其他不良反應（包括支氣管痙攣、嗆咳、屏氣、血氧飽和度下降）的發生情況兩組無差異，右美托咪定也能降低麻醉恢復期間小兒的平均動脈壓和心率。但應用右美托咪定會延長小兒七氟醚麻醉的蘇醒時間［MD=2.14，95%CI（0.95，3.33），P=0.000 4］、拔管（或移除喉罩）時間［MD=1.26，95%CI（0.51，2.00），P=0.000 9］及PACU停留時間［MD=4.72，95%（2.07，7.38），P=0.000 5］。
結論　右美托咪定能降低小兒七氟醚全麻恢復期間躁動的發生率，且有利于維持麻醉恢復期間血流動力學的穩定，但會延長全麻后蘇醒時間、拔管（或移除喉罩）時間、PACU停留時間，也會增加術后嗜睡的發生率。

引用本文： 陳鳳收,馬虹. 右美托咪定對小兒七氟醚全麻恢復期間影響的Meta分析. 中國循證醫學雜志, 2013, 13(5): 580-587. doi: 10.7507/1672-2531.20130102 復制

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.	張加強, 孟凡民, 侯艷華, 等. 右旋美托咪啶對小兒七氟醚麻醉蘇醒期躁動及血流動力學的影響. 臨床麻醉學雜志, 2010, 26(7): 627-628.
10.	房潔渝, 肖亮燦, 郭雋英, 等. 右美托咪啶預防兒童全身麻醉后躁動的臨床研究. 中國醫藥指南, 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, 陳彥青, 鄒聰華. 右美托咪啶對七氟醚麻醉患兒麻醉恢復期躁動的影響. 中華麻醉學雜志, 2011, 31(2): 166-167.
13.	金約西, 李軍. 右美托咪啶用于小兒全麻蘇醒期躁動的臨床觀察. 中國醫院藥學雜志, 2011, 31(13): 1117-1120.
14.	薛濤, 孫紅梅, 孫劍. 右美托咪啶減輕小兒全身麻醉術后躁動的臨床觀察. 山西醫藥雜志, 2011, 40(8): 783-784.
15.	黃毓嬋, 房潔瑜, 朱瓊芳. 右美托咪啶預防兒童術后躁動的觀察及護理.臨床護理雜志, 2011, 10(5): 51-53.
16.	朱瓊芳, 房潔渝, 陳旭素. 全麻誘導前應用右美托咪啶對腺樣體切除術兒童蘇醒期應激反應的影響. 中山大學學報(醫學科學版), 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.	劉建平. 系統評價. 見: 梁萬年, 主編. 醫學科研方法學. 第1版. 北京: 人民衛生出版社, 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.	趙博, 馬虹. 右旋美托咪啶用于椎管內麻醉隨機對照試驗的Meta分析. 中國循證醫學雜志, 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. 張加強, 孟凡民, 侯艷華, 等. 右旋美托咪啶對小兒七氟醚麻醉蘇醒期躁動及血流動力學的影響. 臨床麻醉學雜志, 2010, 26(7): 627-628.
10. 房潔渝, 肖亮燦, 郭雋英, 等. 右美托咪啶預防兒童全身麻醉后躁動的臨床研究. 中國醫藥指南, 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, 陳彥青, 鄒聰華. 右美托咪啶對七氟醚麻醉患兒麻醉恢復期躁動的影響. 中華麻醉學雜志, 2011, 31(2): 166-167.
13. 金約西, 李軍. 右美托咪啶用于小兒全麻蘇醒期躁動的臨床觀察. 中國醫院藥學雜志, 2011, 31(13): 1117-1120.
14. 薛濤, 孫紅梅, 孫劍. 右美托咪啶減輕小兒全身麻醉術后躁動的臨床觀察. 山西醫藥雜志, 2011, 40(8): 783-784.
15. 黃毓嬋, 房潔瑜, 朱瓊芳. 右美托咪啶預防兒童術后躁動的觀察及護理.臨床護理雜志, 2011, 10(5): 51-53.
16. 朱瓊芳, 房潔渝, 陳旭素. 全麻誘導前應用右美托咪啶對腺樣體切除術兒童蘇醒期應激反應的影響. 中山大學學報(醫學科學版), 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. 劉建平. 系統評價. 見: 梁萬年, 主編. 醫學科研方法學. 第1版. 北京: 人民衛生出版社, 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. 趙博, 馬虹. 右旋美托咪啶用于椎管內麻醉隨機對照試驗的Meta分析. 中國循證醫學雜志, 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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右美托咪定對小兒七氟醚全麻恢復期間影響的Meta分析

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《中國循證醫學雜志》

右美托咪定對小兒七氟醚全麻恢復期間影響的Meta分析

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