α2肾上腺素能受体激动剂预防冠心病患者术后心脏不良事件的效果：Meta分析  

Efficacy of alpha-2 adrenergic agonists for prevention of postoperative cardiac adverse events in patients with coronary disease： a meta-analysis

作　　者：郭海[1] 郑宏[1] 马海平[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐市830054

出　　处：《中华麻醉学杂志》2012年第9期1058-1061,共4页Chinese Journal of Anesthesiology

基　　金：新疆维吾尔自治区科技支疆项目重点指令性计划项目（200991126）

摘　　要：目的采用Meta分析评价α2肾上腺素能受体激动剂预防冠心病患者术后心脏不良事件的效果。方法检索MEDLINE、EMBASE、CINAHL、WebofScience、中国生物医学文献数据库和中国期刊全文数据库，收集全身麻醉下采用α2肾上腺素能受体激动剂预防冠心病患者术后心脏不良事件的随机对照研究。采用Cochrane系统评价法评价所纳入文献的质量，评价指标包括：术后心肌梗死发生率、心肌缺血发生率、心动过缓发生率和低血压发生率。采用RevMan5．1软件进行Meta分析。结果纳入15项研究，9篇为高等质量文献，4篇为中等质量文献，2篇为低等质量文献。共3422例患者，应用α2肾上腺素能受体激动剂（包括可乐定和右美托咪定）1790例，应用安慰剂1632例；非心脏手术724例，心脏手术2698例。α2肾上腺素能受体激动剂可降低冠心病患者非心脏手术后心肌梗死生牢，啦肾上腺素能受体激动剂可降低冠心病患者非心脏手术和心脏手术后心肌缺血发生率，啦肾上腺素能受体激动剂可升高冠心病患者非心脏手术后心动过缓发生率（P〈0．05），对冠心病患者心脏手术后心肌梗死发生率和冠心病患者术后低血压发生率无影响（P〉0．05）。结论α2肾上腺素能受体激动剂虽然可诱发心动过缓，但是可降低冠心病患者术后严重心脏不良事件发牛，且可乐定和右荚托咪定的效果一致。Objective To evaluate the efficacy of a2 adrenergic agonists for the prevention of postoperative adverse cardiac events in patients with coronary disease.Methods MEDL1NE, EMBASE, CINHAL, Web of Sci- ence, CBM and CNKI were searched to identify all randomized controlled trials on the efficacy of α2 adrenergic ago- nists for the prevention of postoperative cardiac complications following operation performed under general anesthesia in patients with coronary artery disease. The incidence of myocardial ischemia, myocardial infarction, bradycardia and hypotension were evaluated. Meta-analysis was conducted using the RevMan 5.1 software. Results Fifteen trials included 9 high-quality trials, 4 medium-quality trials and 2 low-quality trials. A total of 3422 patients were included in this meta-analysis. 1790 patients received α2 adrenergic agonists （clonidine and dexmcdetomidine） and 1632 patients received placebo; 724 patients underwent non-cardiac surgery and 2698 patients underwent cardiac surgery. Meta-analysis indicated that α2 adrenergic agonists reduced incidence of myocardial infarction following non-cardiac surgery and myocardial ischemia following non-cardiac surgery and cardiac surgery. Alpha-2 adrenergic agonists significantly increased the incidence of postoperative bradycardia. Conclusion Alpha-2 adrencrgic ago- nists can decrease postoperative cardiac adverse events in patients with coronary disease, but can induce bradycar- dia, and the efficacy of clonidine is consistent with that of dexmedctomidine.

关 键 词：肾上腺素能α激动剂 冠心病 手术后并发症 META分析 心脏不良事件 

分 类 号：R614[医药卫生—麻醉学]