长托宁用于全身麻醉前用药的有效性评价  

Artesunate for Severe Malaria:A Systematic Review of Randomized Trials

作　　者：原志军[1] 马翠霞[2] 曹德全[3] 

机构地区：[1]中南大学湘雅二医院麻醉科,长沙410000 [2]长治医学院附属和济医院呼吸科,山西长治046000 [3]长治医学院附属和济医院麻醉科,山西长治046000

出　　处：《中国循证医学杂志》2008年第5期352-357,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价长托宁作为全身麻醉前用药是否能减少呼吸道粘液分泌和维持心率稳定。方法计算机检索Cochrane图书馆(2007年第3期)、MEDLINE(1966～2007.4)、EMbase(1988～2007.4)、CBMweb(1978～2007.4)、VIP(1989～2007.4)和CNKI(1994～2007.4),收集所有长托宁用于全身麻醉前用药的随机对照试验(RCT),使用Cochrane系统评价方法,评价纳入研究的方法学质量并提取有效数据进行分析。结果共纳入23个RCT,共2790例患者。各纳入研究的方法学质量均为B级,仅1篇文献正确描述了随机分配方法。其中11个RCT比较了长托宁与阿托品作为全身麻醉前用药的疗效,但仅2个RCT比较了术毕气道分泌物量的差异,结果显示差异有统计学意义[WMD=–8.00,95%CI(–8.16,–7.85),P<0.00001],长托宁作为术前用药可以有效减少呼吸道粘液分泌。12个RCT比较了长托宁与东莨菪碱的疗效,但仅2个RCT比较了术毕气道分泌物量的差异,结果显示差异无统计学意义[WMD=–17.07,95%C(I–45.49,11.35),P=0.24]。3个RCT比较了长托宁和安慰剂的疗效,结果显示差异有统计学意义[WMD=–10.60,95%CI(–13.64,–7.56),P<0.00001]。尚未检索出比较长托宁不同剂量用于全身麻醉前用药的文献。7个RCT报告了用药后的不良反应,未发现严重不良反应。结论与阿托品比较,长托宁能有效减少呼吸道粘液分泌且副作用发生率明显较低;与东莨菪碱比较,长托宁疗效与东莨菪碱相似;与不用药比较,长托宁效果明显。但因证据强度较低,本系统评价结论尚需更多高质量RCT进一步论证。Objective To investigate the effect of penehydidime hydrochloride as the preanesthetic medication for general anesthesia, and also to provide evidence for dinical practice. Methods We searched The Cochrane library （2007, Issue 3）, MEDLINE （1966 to 2007）, EMBASE （1988 to 2007）, CBM （1978 to 2007）, VIP （1989 to 2007） and CNKI （1994 to 2007）. Randomised trials comparing penehyclidime hydrochloride with other drugs were collected. Quality assessment and data extraction were performed. Results A total of 23 trials were included, and the quality of all studies was low. Among them, 11 trials compared penehydidime hydrochloride with atropine, of which only 2 measured the airway secretion volume and indicated that the airway secretion volume was smaller in the penehydidime hydrochloride group than that in the atropine group （WMD -8.00, 95%CI -8.16 to -7.85, P〈0.000 01）. Twelve trials compared penehydidime hydrochloride with scopolamine, of which only 2 measured the airway secretion volume and revealed no significant difference between the two groups （WMD -17.07, 95%CI -45.49 to 11.35, P=0.24）. Three trials compared penehyclidime hydrochloride with placebo, which showed that the airway secretion volume was smaller in the penehydidime hydrochloride group than that in the placebo group （WMD -10.60, 95%CI -13.64 to -7.56, P〈0.000 01）. No significant adverse drug reactions were found. Conclusion Current evidence suggested that penehyclidime hydrochloride was not inferior to other drugs in decreasing airway secretion and keeping heart rate stable.

关 键 词：长托宁 全身麻醉 系统评价 随机对照试验 

分 类 号：R614[医药卫生—麻醉学] R971.92[医药卫生—外科学]