不同药物降低小儿扁桃体腺样体切除术后苏醒期躁动发生率效果的比较:网状Meta分析  

Comparison of efficacy of different drugs in reducing incidence of emergence agitation after tonsillectomy and adenoidectomy in pediatric patients:a network meta-analysis

作　　者：董正华[1] 刘茜 耿晓媛 杜宁宁 方建超 杨波 魏晓永[1] Dong Zhenghua;Liu Xi;Geng Xiaoyuan;Du Ningning;Fang Jianchao;Yang Bo;Wei Xiaoyong(Department of Anesthesiology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院麻醉科,郑州450052

出　　处：《中华麻醉学杂志》2023年第12期1445-1450,共6页Chinese Journal of Anesthesiology

摘　　要：目的采用网状Meta分析的方法比较不同药物降低小儿扁桃体腺样体切除术后苏醒期躁动发生率的效果。方法计算机检索Cochrane Library、Pubmed、Web of Science、EMBASE、知网、万方和中国生物医学文献数据库等,搜索通过干预措施降低小儿扁桃体腺样体切除术后苏醒期躁动发生率的随机对照试验(RCT),检索时限均从建库至2023年7月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用STATA 17.0软件依据频率学框架进行网状Meta分析。结果共纳入20篇RCT,患者1687例。与安慰剂比较,10种干预措施能降低小儿扁桃体腺样体切除术后苏醒期躁动发生率,概率排序依次为:右美托咪定[OR值及其95%CI为0.13(0.09~0.20)]、氯胺酮[OR值及其95%CI为0.15(0.08~0.26)]、可乐定[OR值及其95%CI为0.15(0.05~0.50)]、曲马多[OR值及其95%CI为0.16(0.04~0.61)]、瑞马唑仑[OR值及其95%CI为0.17(0.06~0.47)]、阿芬太尼[OR值及其95%CI为0.22(0.08~0.62)]、瑞芬太尼[OR值及其95%CI为0.24(0.12~0.48)]、地佐辛[OR值及其95%CI为0.29(0.12~0.69)]、芬太尼[OR值及其95%CI为0.31(0.19~0.52)]及丙泊酚[OR值及其95%CI为0.46(0.24~0.86)];4种干预措施可降低术后补救用药的使用率,概率排序依次为:右美托咪定[OR值及其95%CI为0.19(0.11~0.32)]、曲马多[OR值及其95%CI为0.20(0.10~0.42)]、氯胺酮[OR值及其95%CI为0.49(0.28~0.86)]及芬太尼[OR值及其95%CI为0.49(0.32~0.77)];1种干预措施可降低术后恶心呕吐发生率:右美托咪定[OR值及其95%CI为0.54(0.31~0.94)]。结论右美托咪定降低小儿扁桃体腺样体切除术后苏醒期躁动发生率的效果最好。Objective To compare the efficacy of different drugs in reducing incidence of emergence agitation after tonsillectomy and adenoidectomy in the pediatric patients.Methods Cochrane Library,PubMed,Web of Science,EMBASE,China National Knowledge Infrastructure,Wanfang and Chinese Biomedical Literature Databases were searched from inception to July 2023 for the randomized controlled trials involving interventions to reduce the incidence of emergence agitation after tonsillectomy and adenoidectomy in pediatric patients.Two researchers independently screened the literature,extracted data,and evaluated the risk of bias in the included studies.STATA 17.0 software was used to conduct a network meta-analysis according to the frequency-ology framework.Results Twenty randomized controlled trials were finally included,involving 1687 patients.Compared with placebo,10 interventions could reduce the incidence of emergence agitation in pediatric patients after tonsillectomy and adenoidectomy,and the order of probability was as follows:dexmedetomidine(OR and 95%confidence interval[CI]0.13[0.09-0.20]),ketamine(OR and 95%CI 0.15[0.08-0.26]),clonidine(OR and 95%CI 0.15[0.05-0.50]),tramadol(OR and 95%CI 0.16[0.04-0.61]),remazolam(OR and 95%CI 0.17[0.06-0.47]),afentanil(OR and 95%CI 0.22[0.08-0.62]),remifentanil(OR and 95%CI 0.24[0.12-0.48]),desocine(OR and 95%CI 0.29[0.12-0.69]),fentanyl(OR and 95%CI 0.31[0.19-0.52])and propofol(OR and 95%CI 0.46[0.24-0.86]).Four interventions cloud reduce the usage rate of postoperative rescue drugs,and the probability was ranked as follows:dexmedetomidine(OR and 95%CI 0.19[0.11-0.32]),tramadol(OR and 95%CI 0.20[0.10-0.42]),ketamine(OR and 95%CI 0.49[0.28-0.86])and fentanyl(OR and 95%CI 0.49[0.32-0.77]).One intervention cloud reduce the incidence of postoperative nausea and vomiting:dexmedetomidine(OR and 95%CI 0.54[0.31-0.94]).Conclusions Dexmedetomidine provides the best effect in reducing the incidence of emergence agitation after pediatric tonsillectomy and adenoidectomy.

关 键 词：苏醒谵妄 扁桃体切除术 网状Meta分析 

分 类 号：R726.1[医药卫生—儿科]