| 189 | 14 | 18 |
| 下载次数 | 被引频次 | 阅读次数 |
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。
Abstract：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.
1 Cherng CH,Yang CP,Wong CS.Epidural fentanyl speeds the onset of sensory and motor blocks during epidural ropivacaineanesthesia[J].Anesth Analg,2005,101(6):1834-1837.
2 Gürkan Y,Canatay H,Baykara N,et al.Comparison of bupivacaine-fentanyl versus bupivacaine-morphine for patient controlled epidural analgesia[J].J Turkish SocAlgol,2005,17(2):40-43.
3 Arain SR,Ebert TJ.The efficacy,side effects,and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation[J].AnesthAnalg,2002,95(2):461-466.
4 Gómez-Vázquez ME,Hernández-Salazar E,Hernández-Jiménez A,et al.Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery[J].J ClinAnesth,2007,19(8):576-582.
5 Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
6 Bajwa SJ,Arora V,Kaur J,et al.Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries[J].Saudi JAnaesth,2011,5(4):365-370.
7 Kazim M,Kothari V,Priyadarshi S,et al.A comparative study to assess the effect of dexmedetomidine and fentanyl as an adjuvant to ropivacaine for epidural anesthesia in percutaneous nephrolithotomy[J].Anaesthesia,Pain and Intensive Care,2017,21(1):59-64.
8 Kiran S,Jinjil K,Tandon U,et al.Evaluation of dexmedetomidine and fentanyl as additives to ropivacaine for epidural anesthesia and postoperative analgesia[J].J Anaesthesiol Clin Pharmacol,2018,34(1):41-45.
9 伍志超,王涵,冯艳,等右美托咪定或芬太尼复合罗哌卡因硬膜外麻醉对下肢骨科手术患者术后镇痛的比较[J].重庆医学,2019:1-10.
10 徐灿.右美托咪啶与芬太尼分别复合罗哌卡因硬膜外麻醉临床应用比较[J].家庭医药,2018,(8):108.
11 汪涛,王志春,朱安祥,等.硬膜外注射右美托咪定、芬太尼用于下肢手术镇痛的效果评价[J].国际麻醉学与复苏杂志,2015,36(4):310-314.
12 钱鹏,邹振宇,宋仕钦,等.右美托咪定与芬太尼复合罗哌卡因硬膜外麻醉的对比研究[J].中国煤炭工业医学杂志,2015,18(8):1341-1345.
13 韩传宝,蒋秀红,吴霞,等.右美托咪啶复合罗哌卡因硬膜外麻醉在剖宫产患者中的应用[J].中华医学杂志,2014,(44):3501-3505.
14 马凤伟.剖宫产应用右美托咪啶复合罗哌卡因硬膜外麻醉的可行性研究[J].临床医药文献电子杂志,2017,4(48):9386.
15 Solovyova O,Lewis CG,Abrams JH,et al.Local infiltration analgesia followed by continuous infusion of local anesthetic solution for total hip arthroplasty:a prospective,randomized,double-blind,placebo-controlled study[J].J Bone Joint Surg Am,2013,95(21):1935-1941.
16 文武君,孟海港.比较右美托咪啶与芬太尼分别与罗哌卡因复合用于硬膜外麻醉中的效果[J].世界最新医学信息文摘,2019,19(36):113,122.
17 Salom?ki TE,Laitinen JO,Nuutinen LS.A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy[J].Anesthesiology,1991,75(5):790-795.
18 Lorenzini C,Moreira LB,Ferreira MB.Efficacy of ropivacaine compared with ropivacaineplus sufentanil for postoperative analgesia after major knee surgery[J].Anaesthesia,2002,57(5):424-428.
19 Piccinini Filho L,Mathias LA,MalheirosCA,et al.Dexmedetomidine in morbid obese patients undergoing gastroplasty:cardiovascular stability and consumption of intravenous anesthetics.A retrospective study[J].Rev Bras Anestesiol,2006,56(2):109-118.
20 Kaur S,AttriJP,Kaur G,et al.Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries[J].Saudi J Anaesth,2014,8(4):463-469.
基本信息:
DOI：10.13210/j.cnki.jhmu.20190827.002
中图分类号:R614
引用信息:
[1]张艺,邱珍,夏中元.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[J].海南医学院学报,2019,25(18):1410-1416.DOI:10.13210/j.cnki.jhmu.20190827.002.
基金信息:
中国高校医学期刊临床专项资金项目(11221022)~~
2019-08-28
2019-08-28
2019-08-28