右美托咪定对高血压患者全身麻醉恢复期拔管反应和苏醒时间影响的Meta分析

目的 系统评价右美托咪定（dexmedetomidine， Dex）对高血压患者全身麻醉恢复期拔管反应和苏醒时间的影响。 方法 计算机检索万方、知网、维普、PubMed、Embase、The Cochrane Library，查找有关Dex对高血压患者全身麻醉恢复期拔管反应和苏醒时间的影响的随机对照实验（randomized controlled trial， RCT），同时追溯纳入文献的参考文献。对符合纳入标准的文献进行质量评价和资料提取，采用RevMan5.3软件进行Meta分析。 结果 最终纳入16项RCT，1 280例患者。Meta分析的结果显示： ① 主要结局指标：Dex降低盆腹腔手术［加权均数差（weighted mean difference， WMD）及其95%CI为-18.59（-22.46^-14.72），P〈0.05］、其他类型手术［-17.41（-25.70^-9.12），P〈0.05］拔管即刻MAP；降低拔管即刻HR，盆腹腔手术及其他类型手术的WMD及其95%CI分别为［-19.18（-26.59^-11.76），P〈0.05］，［-11.86（-22.21^-1.51），P〈0.05］；Dex并不延长睁眼时间［WMD=0.40，95%CI（-0.04~0.83），P=0.07］和拔管时间［WMD=0.33，95%CI （-0.08~0.75），P=0.12］。② 次要结局指标：Dex可降低拔管期躁动［合并效应的比值比（odda radio， OR）=0.17，95%CI （0.08~0.34），P〈0.05］、呛咳［OR=0.19，95%CI （0.10~0.36），P〈0.05］，但并不减少恶心呕吐［OR=0.51，95%CI （0.16~1.64），P=0.26］。 结论 Dex辅助全身麻醉可抑制高血压患者拔管心血管应激反应，改善高血压患者全身麻醉拔管期苏醒时间。

Effect of dexmedetomidine on responses to endotracheal extubation and recovery time after general anesthesia in patients with hypertension:a Meta-analysis

Objective In this study, Meta-analysis was performed to systematically evaluate effects of dexmedetomidine (Dex) on responses to endotracheal extubation and recovery time after general anesthesia in patients with hypertension. Methods Randomized controlled trial (RCT) about the influence of Dex on endotracheal extubation and recovery quality after general anesthesia in patients with hypertension were collected by searching WanFang Data, CNKI, VIP, Pubmed, Embase, and Cochrane library. RevMan 5.3 was used for Meta-analysis. Results A total of 1280 patients in 16 RCTs were included. In patients subjected to pelvic and abdominal surgery or other surgeries, Dex reduced cardiovascular response to tracheal extubation:decreasing MAP and HR by about 10%-20%; did not prolong recovery time and extubation time; but, reduced postoperative agitation and bucking. There was no significant difference in nausea and vomiting. Conclusions In patients subjected to surgeries, Dex significantly attenuated the cardiovascular responses to tracheal extubation after general anesthesia, and effectively improve recovery from anesthesia.