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    王志萍, 龙焱, 李静静, 马舒玉, 张慧敏. 右美托咪定滴鼻对小儿七氟醚麻醉苏醒期躁动的影响：一项随机、安慰剂对照试验的meta分析[J]. 徐州医科大学学报, 2020, 40(2): 83-88.
    引用本文: 王志萍, 龙焱, 李静静, 马舒玉, 张慧敏. 右美托咪定滴鼻对小儿七氟醚麻醉苏醒期躁动的影响：一项随机、安慰剂对照试验的meta分析[J]. 徐州医科大学学报, 2020, 40(2): 83-88.
    shu
    Effect of intranasal dexmedetomidine on emergence agitation in pediatric patients with sevoflurane anesthesia:a me＜x＞ta-analyisis of randomized placebo-controlled trials[J]. Journal of Xuzhou Medical University, 2020, 40(2): 83-88.
    Citation: Effect of intranasal dexmedetomidine on emergence agitation in pediatric patients with sevoflurane anesthesia:a me＜x＞ta-analyisis of randomized placebo-controlled trials[J]. Journal of Xuzhou Medical University, 2020, 40(2): 83-88.
    shu

    右美托咪定滴鼻对小儿七氟醚麻醉苏醒期躁动的影响：一项随机、安慰剂对照试验的meta分析

    Effect of intranasal dexmedetomidine on emergence agitation in pediatric patients with sevoflurane anesthesia:a me＜x＞ta-analyisis of randomized placebo-controlled trials

      摘要
    • 摘要: 目的 通过meta分析方法评价右美托咪定滴鼻对小儿七氟醚麻醉苏醒期躁动的影响。 方法 计算机检索PubMed、EMbase、Web of Science、Cochrane Library、中国期刊全文数据库、维普、和万方数据库，搜集右美托咪定滴鼻对小儿七氟醚麻醉苏醒期躁动影响的随机对照试验（randomized controlled trial,RCT），检索时限均从建库至2019年10月。主要结局指标是苏醒期躁动的发生率，次要结局指标包括采用苏醒时间、拔管时间、PACU停留时间、镇痛补救发生率以及不良反应。采用RevMan 5.3对纳入研究进行me＜x＞ta分析并根据右美托咪定不同给药剂量和给药时间对相关指标进行亚组分析。 结果 共纳入文献12篇，共计762例患儿，其中右美托咪定滴鼻组443例，对照组319例。me＜x＞ta分析结果显示：两组间的PACU停留时间无明显差异（P＞0.05），但右美托咪定滴鼻组的镇痛补救发生率明显降低（RR=0.22, 95%CI 0.14,0.35 P＜0.00001）、重度苏醒期躁动发生率明显降低（RR=0.20，95%CI 0.09,0.44,P＜0.0001）以及术后恶心呕吐（PONV）发生率降低（RR=0.44, 95%CI 0.24,0.84 P=0.01）。亚组分析结果表明1μg/kg和2μg/kg右美托咪定滴鼻均能降低患儿七氟醚麻醉苏醒期躁动发生率（RR=0.29，95%CI 0.20,0.42,P＜0.00001 和 RR=0.21，95%CI 0.08,0.57,P=0.002 ），延长苏醒时间（MD=1.48 95%CI 0.21,2.76 P=0.02和 MD=2.83 95%CI 0.72,4.94 P=0.009）和拔管时间（MD=0.66 95%CI 0.29,1.03 P=0.00005 和 MD=1.61 95%CI 0.50,2.72 P=0.004），右美托咪定滴鼻术前给药（包括麻醉诱导前）和术中给药（包括麻醉诱导后）均能明显降低苏醒期躁动发生率（RR=0.26，95%CI 0.19,0.35,P＜0.00001 和 RR=0.27，95%CI 0.20,0.38,P=0.002）。 结论 右美托咪定滴鼻能够降低患儿七氟醚麻醉苏醒期躁动发生率和严重程度，降低患儿镇痛补救发生率和PONV发生率，对PACU停留时间无明显影响，但可能会延长苏醒时间和拔管时间。

       

      Abstract: objective To evaluate the effects of intranasal dexmedetomidine on emergence agitation (EA) in pediatric patients with sevoflurane anesthesia. Methods We searched PubMed, EMba＜x＞se, Web of Science, The Cochrane Library, China National Knowledge Infrastructure，VIP, Wan?Fang databa＜x＞ses for clinical randomized controlled trials investigating the effect of intranasal dexmedetomidine on emergence agitation in pediatric patients with sevoflurane anesthesia from inception to October 2019.The primary outcome was the incidence of EA.Secondary outcomes included emergence time、extubation time、length of PACU stay、incidence of rescue analgesia and adverse effects. RevMan 5.3 software was used for me＜x＞ta analysis of included studies. Subgroup analysis was performed according to different doses and different time of dexmedetomidine administration. Results Twelve randomized controlled trials involving a total of 762 patients,with 443 patients receiving intranasal dexmedetomidine and 319 patients receiving intranasal saline, were included in the me＜x＞ta-analysis. The results of me＜x＞ta-analysis showed that no significant differences were found in length of PACU stay between two groups (P>0.05). However, compared with placebo group, the incidence of severe EA was significantly decreased（RR=0.22, 95%CI 0.14,0.35 P＜0.00001）,the incidence of rescue analgesia was significantly decreased（RR=0.20，95%CI 0.09,0.44,P＜0.0001) and the incidence of PONV was also significantly decreased(RR=0.44, 95%CI 0.24,0.84 P=0.01).Subgroup analysis suggested that both 1μg/kg and 2μg/kg intranasal dexmedetomidine could significanlty decrease the incidence of EA （RR=0.29，95%CI 0.20,0.42,P＜0.00001 and RR=0.21，95%CI 0.08,0.57,P=0.002)，prolong the emergence time（MD=1.48 95%CI 0.21,2.76 P=0.02 and MD=2.83 95%CI 0.72,4.94 P=0.009）and extubation time（MD=0.66 95%CI 0.29,1.03 P=0.00005 and MD=1.61 95%CI 0.50,2.72 P=0.004）.Both preoperative and intraoperative dexmedetomidine could significanlty decrease the incidence of EA(RR=0.26，95%CI 0.19,0.35,P＜0.00001 and RR=0.27,95%CI 0.20,0.38,P=0.002). Conclusion Intranasal dexmedetomidine could significanly reduce the incidence and severity of EA ,decrease the incidence of rescue analgesia and the incidence of PONV with no effect on length of PACU stay,but is likely to prolong the emergence time and extubation time.

       

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