【摘要】 目的 评价α2受体激动剂是否可以降低七氟烷引起的小儿术后躁动的发生率。 方法 通过检索Medline、荷兰医学文摘、Cochrane临床试验数据库、中国生物医学文献数据库和中国期刊网全文数据库等数据库，收集可乐定或右美托咪啶对七氟烷引起的小儿术后躁动的预防作用的随机对照试验（randomized controlled trial，RCT），提取资料和评估方法学质量，采用Cochrane协作网RevMan 5.0软件进行Meta分析。 结果 最终纳入11个RCT，其中104例患儿预防性使用右美托咪啶，268例患儿使用可乐定，365例患儿使用安慰剂。Meta分析显示，可乐定组小儿术后躁动发生率的比值比（OR）为0.31，95%CI为（0.15，0.61）（P=0.000 8）；右美托咪啶组小儿术后躁动发生率的OR为0.16，95%CI为（0.08，0.31）（Plt;0.000 01）。 结论 α2受体激动剂可以显著降低七氟烷引起的小儿术后躁动的发生率。【Abstract】 Objective To determine whether alpha2-adrenoceptor agonists can decrease emergence agitation (EA) in pediatric patients after sevoflurane anesthesia. Methods The Medline, Embase, Cochrane Library, CBM and CNKI were searched. All randomized controlled trials comparing clonidine or dexmedetomidine with other interventions in preventing emergence agitation after sevoflurane anesthesia were retrieved. Study selection and assessment, data collection and analyses were undertaken. Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software. Results Eleven articles reached our inclusion criteria and were included in the Meta-analysis. A total of 104 children treated with dexmedetomidine, 268 children treated with clonidine, and 365 children treated with placebo were evaluated for the incidence of emergence agitation. The pooled odds ratio for the clonidine subgroup was 0.31, with a 95% confidence interval of 0.15-0.61 (P=0.000 8). The pooled odds ratio for the dexmedetomidine subgroup was 0.16, with a 95% confidence interval of 0.08-0.31 (Plt;0.000 01). Conclusion Alpha2-adrenoceptor agonists can significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.
Objective To evaluate the sedative and analgesic efficacy and adverse effect of dexmedetomidine versus propofol on the postoperative patients in intensive care unit (ICU). Methods The relevant randomized controlled trials (RCTs) were searched in The Cochrane Library, MEDLINE, PubMed, SCI, SpringerLinker, ScinceDirect, CNKI, VIP, WanFang Data and CBM from the date of their establishment to November 2011. The quality of the included studies was evaluated after the data were extracted by two reviewers independently, and then the meta-analysis was performed by using RevMan 5.1. Results Ten RCTs involoving 793 cases were included. The qualitative analysis results showed: within a certain range of dosage as dexmedetomidine: 0.2-2.5 μg/(kg·h), and propofol: 0.8-4 mg/(kg·h), dexmedetomidine was similar to propofol in sedative effect, but dexmedetomidine group needed smaller dosage of supplemental analgesics during the period of sedative therapy. The results of meta-analysis showed: the percentage of patients needing supplemental analgesics in dexmedetomidine group was less than that in propofol group during the period of sedative therapy (OR=0.24, 95%CI 0.08 to 0.68, P=0.008). Compared with the propofol group, the duration of ICU stay was significantly shorter in the dexmedetomidine group (WMD= –1.10, 95%CI –1.88 to –0.32, P=0.006), but the mechanical ventilated time was comparable between the two groups (WMD=0.89, 95%CI –1.15 to 2.93, P=0.39); the incidence of adverse effects had no significant difference between two groups (bradycardia: OR=3.57, 95%CI 0.86 to 14.75, P=0.08; hypotension: OR=1.00, 95%CI 0.30 to 3.32, P=1.00); respiratory depression seemed to be more frequently in propofol group, which however needed further study. Mortalities were similar in both groups after the sedative therapy (OR=1.03, 95%CI 0.54 to 1.99, P=0.92). Conclusion Within an exact range of dosage, dexmedetomidine is comparable with propofol in sedative effect. Besides, it has analgesic effect, fewer adverse effects and fewer occurrences of respiratory depression, and it can save the extra dosage of analgesics and shorten ICU stay. Still, more larger-sample, multi-center RCTs are needed to provide more evidence to support this outcome.
目的 观察右美托咪啶复合舒芬太尼用于经腹子宫全切术后患者自控静脉镇痛（PCIA）的效果。 方法 2011年3月－2012年6月选择经腹子宫全切术患者90例，年龄39～68岁，体重48～72 kg，美国麻醉医师协会分级Ⅰ～Ⅱ级。采用随机数字表法，将患者随机分为3组，每组各30例。于手术结束即刻行PCIA。对照组（C组）采用舒芬太尼150 μg+昂丹司琼12 mg；S1组采用右美托咪定200 μg+舒芬太尼100 μg+昂丹司琼12 mg；S2组采用右美托咪定200 μg+舒芬太尼150 μg+昂丹司琼12 mg。3组均用生理盐水稀释至100 mL，负荷剂量均为舒芬太尼0.1 μg/kg，静脉镇痛泵背景输注速度2 mL/h，自控给药剂量0.5 mL，锁定时间15 min。记录术后6、12、24和48 h Ramsay镇静评分和视觉模拟评分（VAS），记录不良反应发生情况和患者对术后镇痛的满意度。 结果 3组患者均能获得较好的镇痛效果。其中C组VAS评分较低，但恶心、呕吐、皮肤瘙痒发生率升高；与C组相比，Sl组和S2组Ramsay镇静评分升高，恶心、呕吐、皮肤瘙痒发生率降低，患者满意度升高。S1组患者满意度最高；S2组VAS评分最低。3组均未发生心动过缓、低血压、过度镇静和呼吸抑制。 结论 右美托咪啶可增加经腹子宫全切术患者术后舒芬太尼自控静脉镇痛的效果，提高患者满意度，降低不良反应。
目的 观察比较右美托咪啶复合丙泊酚应用于无痛纤维支气管镜检查，及对呼吸循环、苏醒时间的影响和不良反应。 方法 2011年3月－2012年12月选择美国麻醉师协会评分Ⅰ～Ⅱ级行无痛纤维支气管镜检查患者50例，采用随机数字表法分为两组（n=25），即右美托咪啶复合丙泊酚组（A组）和芬太尼复合丙泊酚组（B组）。A组术前15 min给盐酸右美托咪啶负荷剂量0.6～0.8 μg/kg泵入，B组泵入相同剂量的生理盐水后，缓慢静注芬太尼0.05 mg；两组静注1～2 mg/kg丙泊酚负荷量，后以2～4 mg/（kg·h）泵注丙泊酚维持。记录两组患者麻醉前、置纤维支气管镜前、置纤维支气管镜后2 min、15 min、苏醒时的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、血氧饱和度（SpO2）和心电图（ECG）等情况，并记录手术时间、术后苏醒时间及丙泊酚用量和检查治疗期间患者肢体躁动、呛咳等情况。 结果 与B组比较，A组术中的MAP、HR和RR较为平稳，缩短了术后苏醒时间，可减少丙泊酚的用量（P＜0.05）。 结论 右美托咪啶复合丙泊酚应用于无痛纤维支气管镜检查，是一种安全、可行的麻醉方法。
Objective To study the sedative effects and safety of dexmedetomidine and midazolamfor acute exacerbate of chronic obstructive pulmonary disease ( AECOPD) underwentmechanical ventilation.Methods 68 AECOPD patients underwentmechanical ventilation were enrolled and randomly divided into adexmedetomidine group ( n =34) and a midazolam group ( n = 34) by acute physiology and chronic healthevaluation Ⅱ ( APACHEⅡ) score. The patients in the dexmedetomidine group were given a loading dose( 1 μg/kg) and then maintained with 0. 2-0. 8 mg·kg- 1 ·h- 1 . The patients in the midazolam group weregiven a loading dose ( 0. 05 mg/kg) and then maintained with 0. 06-0. 2 mg· kg- 1 · h- 1 . Sedation levelwas assessed by Ramsay score and maintained a Ramsay score of 3-4. The sedation onset time, disablesedatives wake time, duration of mechanical ventilation, extubation success rate, ICU length of stay, and 28days mortality after admission to the ICU were compared between two groups. And calmer respiratorydepression, circulatory and delirium adverse reactions incidence were also compared. Results Thedifferences in patients’age, gender, and APACHEⅡ score between two groups were not significant ( P gt;0. 05) . Compared with the midazolam group, the dexmedetomidine group had more rapid onset of sedation[ ( 49. 80 ±8. 20) s vs. ( 107. 55 ±19. 65) s, P lt;0. 01] , shorter wake-up time [ ( 18. 90 ±2. 30) min vs. ( 40. 82 ±19. 85) min, P lt;0. 01] , shorter duration of mechanical ventilation [ ( 4. 9 ±1. 6) d vs. ( 7. 8 ±2. 5) d,P lt;0. 01] , higher successful extubation rate ( 79. 41% vs. 58. 82% , P lt;0. 01) , and shorter ICUlength of stay[ ( 6. 5 ±2. 5) d vs. ( 9. 6 ±3. 4) d, P lt;0. 05] . Dexmedetomidine had lower respiratory depression rate, littleeffects on hemodynamics, lower occurrence and short duration of delirium. Conclusion It is highlyrecommended that dexmedetomidine be used for sedation in AECOPD patients with mechanical ventilation.
ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction in adult patients after receiving noncardiac surgery under general anesthesia. MethodsThe randomized controlled trials (RCTs) about the influence of dexmedetomidine on the early postoperative cognitive dysfunction of patients after receiving noncardiac surgery with general anesthesia was searched in PubMed, EBSCO, Springer, Ovid, The Cochrane Library (Issue 1, 2013), CNKI, VIP, WanFang Data and Google Scholar up to November 30th, 2013. The references of included literature were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 22 RCTs involving 1 356 patients were enrolled. The results of meta-analysis indicated that:a) dexmedetomidine reduced the incidence of postoperative cognitive dysfunction on the first day (RR=0.38, 95%CI 0.29 to 0.49, P < 0.001), on the seventh day (RR=0.55, 95%CI 0.23 to 1.29, P=0.17); improved postoperative MMSE scores after surgery (on the first day:MD=2.38, 95%CI 1.42 to 3.34, P < 0.001; on the seventh day:MD=0.92, 95%CI 0.16 to 1.68, P=0.02), and decreased the expression of inflammatory factor IL-6 (instant:MD=-11.96, 95%CI-18.45 to-5.46, P=0.000 3; after 24 h:MD=-7.50, 95%CI-13.73 to-1.27, P=0.02); and TNF-α (instant:MD=-4.09, 95%CI-7.02 to-1.16, P=0.006)) in patients. b) No significant difference was found between two groups (MD=-0.97, 95%CI-2.37 to 0.43, P=0.17). ConclusionDexmedetomidine can effectively reduce the early-stage postoperative cognitive dysfunction, improve MMSE scores after the operation, and reduce inflammatory reaction. In addition, due to the limited quantity and quality of studies included, larger sample, high quality RCTs are needed to verify the abovementioned conclusion.