右美托咪定对斜视手术麻醉并发症的预防作用：一项系统评价和荟萃分析

以下文章来源于罂粟花 ，作者anesthGH

本文由“罂粟花”授权转载

右美托咪定对斜视手术麻醉并发症的预防作用：一项系统评价和荟萃分析

贵州医科大学       麻醉与心脏电生理课题组

翻译：张中伟

编辑：宋雨婷

审校：曹莹

目的:

右美托咪定是一种具有镇痛、镇静和抗焦虑作用的药物。临床上常用于预防斜视手术相关的常见并发症，包括术后谵妄、术后恶心呕吐、术后疼痛、眼心反射等。但目前对其有效性和副作用的研究较少，关于右美托咪定对其并发症作用效果研究的样本量较小。因此，本研究通过系统评价和荟萃分析来评估右美托咪定预防斜视手术麻醉相关并发症的效果。

方法：

从 10 个常用数据库中检索文献，并查找截至 2022 年 5 月发表的随机对照试验。纳入的研究比较了右美托咪定与安慰剂对手术中麻醉相关并发症的干预效果。评估斜视手术患者术后谵妄、术后恶心呕吐、术后疼痛、眼心反射的发生率。使用 Review Manager 和 STATA 软件生成统计分析和森林图。使用相对风险 (RR) 测量二元结果，每个结果的置信区间为 95%。采用Cochrane 偏倚风险工具评估符合纳入标准的研究中的偏倚和风险。

结果：

最终纳入分析的文章共有 13 篇，其中包括 1018 名接受斜视手术的患者。与安慰剂组相比，右美托咪定组术后谵妄（RR = 0.73，P = 0.001）、严重术后谵妄（RR = 0.45，P = 0.005）、术后恶心和呕吐（RR = 0.48）的发生率明显降低,P < 0.0001），术后需要补充镇痛的概率降低（RR = 0.60，P = 0.004）。此外，静脉注射右美托咪定可显著降低眼心反射的发生率（RR = 0.50，P = 0.001）。相比之下，鼻内给予右美托咪定对眼心反射的发生率没有显著影响（RR = 1.22，P = 0.15）。

结论：

在接受斜视手术的患者中，使用右美托咪定可以缓解术后谵妄，减少术后恶心呕吐以及术后疼痛的发生率。此外，静脉注射右美托咪定可降低眼心反射的发生率。

原始文献来源：

Yiren Chen, Mingjie Li, Yajing Zheng,et al.The preventive effect of dexmedetomidine on anesthesia complications in strabismus surgery: a systematic review and meta-analysis.[J]. BMC Anesthesiology (2023) 23:253

英文原文

The preventive effect of dexmedetomidine on anesthesia complications in strabismus surgery: a systematic review and meta-analysis

Objective: Dexmedetomidine is a medication that has analgesic, sedative, and anti-anxiety properties. In the clinical, it is often used to prevent common complications associated with strabismus surgery, including postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex. However, its effectiveness and side effects of the present studies are different. The sample sizes of the present studies on the prevention of complications of dexmedetomidine are small. Therefore, this study evaluates the efficacy of dexmedetomidine in preventing anesthesia-related complications in strabismus surgery through a systematic review and meta-analysis.

Methods: Literature was retrieved from 10 commonly used databases and randomized controlled trials published up to May 2022 were sought. The included studies compared the intervention effects of dexmedetomidine versus placebo on anesthesia-related complications in surgery. The occurrence rates of postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex in patients undergoing strabismus surgery were evaluated. Statistical analyses and forest plots were generated using Review Manager and STATA software. Binary outcomes were measured using relative risk (RR) with a 95% confidence interval for each outcome. The Cochrane risk of bias tool was used to assess the bias and risk in the studies that met the inclusion criteria.

Results: A total of 13 articles were ultimately included in the analysis, comprising 1,018 patients who underwent strabismus surgery. The dexmedetomidine group, compared to the placebo group, demonstrated significant reductions in the incidence of postoperative delirium (RR = 0.73, P = 0.001), severe postoperative delirium (RR = 0.45, P = 0.005), postoperative nausea and vomiting (RR = 0.48, P < 0.0001), and the need for supplemental analgesia postoperatively (RR = 0.60, P = 0.004). Additionally, subgroup analysis revealed that intravenous administration of dexmedetomidine significantly reduced the incidence of oculocardiac reflex (RR = 0.50, P = 0.001). In contrast, intranasal administration of dexmedetomidine did not have a significant effect on the incidence of oculocardiac reflex (RR = 1.22, P = 0.15).There was a significant difference between the subgroups (P = 0.0005, I2 = 91.7%).

Conclusion: Among patients undergoing strabismus surgery, the use of dexmedetomidine can alleviate postoperative delirium and reduce the incidence of postoperative nausea and vomiting, as well as postoperative pain. Moreover, intravenous administration of dexmedetomidine can lower the occurrence rate of the oculocardiac reflex.

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编辑：Michel.米萱

校对：MiLu.米鹭

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