右美托咪定与芬太尼作为罗哌卡因硬膜外麻醉辅助用药效果比较的Meta分析  

Comparison of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia:a Meta-analysis of randomized controlled trial

作　　者：张艺[1] 邱珍[1] 夏中元[1] ZHANG Yi;QIU Zhen;XIA Zhong-yuan(Department of Anesthesiology,People's Hospital,Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院麻醉科

出　　处：《海南医学院学报》2019年第18期1410-1416,共7页Journal of Hainan Medical University

基　　金：中国高校医学期刊临床专项资金项目(11221022)~~

摘　　要：目的:通过Meta分析比较右美托咪定与芬太尼作为罗哌卡因硬膜外麻醉辅助用药的效果。方法:检索Cochrane图书馆、PubMed、Embase、CNKI、维普、万方数据库,检索时间从建库年至2019年6月。收集右美托咪定与芬太尼作为罗哌卡因硬膜外麻醉辅助用药的临床随机对照研究(RCT),将纳入文献进行质量评价与资料提取,通过Revman5.3软件对纳入研究进行Meta分析评价。结果:共纳入9个RCT,672例患者。Meta分析显示与芬太尼相比,右美托咪定能降低罗哌卡因硬膜外麻醉患者术后恶心呕吐发生率[OR=0.43,95%CI(0.29,0.66),P<0.000 1]、术后寒战发生率[OR=0.34,95%CI(0.18,0.63),P<0.000 1]、加快镇痛作用起效时间[MD=-2.78,95%CI(-4.81,-0.75),P<0.000 1]、延长镇痛时间[MD=99.04,95%CI(82,73,115.34),P<0.000 1]、在非剖宫产手术中增强镇静作用[MD=1.01,95%CI(0.87,1.15),P<0.000 1],但增加了口干的发生率[OR=5.63,95%CI(2.85,11.10),P<0.000 1],减短了神经阻滞的持续时间[MD=-4.35,95%CI(-7.31,-1.40),P<0.000 1],在剖宫产手术中镇静作用不及芬太尼[MD=-0.89,95%CI(-1.39,-0.38),P<0.000 1]。结论:现有证据表明,作为罗哌卡因硬膜外麻醉辅助用药,右美托咪定比芬太尼有更好的镇痛效果,且可降低恶心呕吐、寒战的发生率,但应注意其口干的风险及作用于不同手术时的镇静效果。Objective:To systematically review the efficacy of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia.Methods:To search the Cochrane Library,PubMed,Embase,CNKI,VIP,WanFang Database,search time from the year of construction to June 2019 for all randomized controlled trials(RCTs)about the efficacy of dexmedetomidine versus fentanyl as adjuvants for ropivacaine for epidural anesthesia.The quality of the studies is evaluated by the method recommended by Cochrane Collaboration.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.3 software.Results:Eight RCTs involving 592 patients were included in our Meta-analysis.The results of meta-analysis showed that compared with fentanyl,dexmedetomidine can reduce the incidence of postoperative nausea and vomiting in patients with ropivacaine epidural anesthesia[OR=0.43,95%CI(0.29,0.66),P<0.000 1]and the incidence of post-cold[OR=0.34,95%CI(0.18,0.63),P<0.000 1],accelerated onset of analgesia[MD=-2.78,95%CI(-4.81,-0.75),P<0.000 1],prolonged time of analgesia[MD=99.04,95%CI(82.73,115.34),P<0.000 1],enhanced sedation in non-cesarean section[MD=1.01,95%CI(0.87,1.15),P<0.000 1],but increased the incidence of dry mouth[OR=5.63,95%CI(2.85,11.10),P<0.000 1],shortening the duration of nerve block[MD=-4.35,95%CI(-7.31,-1.40),P<0.000 1],sedation was not as good as fentanyl in cesarean section[MD=-0.89,95%CI(-1.39,-0.38),P<0.000 1].Conclusion:Available evidence suggests that dexmedetomidine,as an adjuvant for ropivacaine for epidural anesthesia,has a better analgesic effect than fentanyl,and can reduce the incidence of nausea,vomiting,and chills,but should pay attention to its risk of dry mouth and the sedative effect on different operations.

关 键 词：右美托咪定 芬太尼 罗哌卡因 硬膜外麻醉 META分析 

分 类 号：R614[医药卫生—麻醉学]