右美托咪定对小儿七氟醚全麻恢复期间影响的Meta分析

目的系统评价有美托咪定对小儿七氟醚全麻恢复期间的影响。方法计算机检索PubMed（1966—2012．3）、TheCochraneLibrary（2012年第1期）、EBSCO（ASP）（1984—2012．3）、Iournals@OvidFullText（1993～2012．3）、CBM（1978～2012．3）、CNKI（1979～2012．3）、VIP（1989—2012．3）和WanFangData（1998～2012．3），同时检索纳入文献的参考文献，纳入探讨右美托咪定对小儿七氟醚全麻恢复期间影响的随机对照试验（RCT）。南两位研究者独立进行资料提取和纳入研究的方法学质量评价后，采用RevMan5．2软件进行Meta分析。结果纳入16个RCT，共1217例患者。Meta分析结果显示：与安慰剂相比，右美托咪定能降低小儿七氟醚全麻恢复期间躁动的发生[OR=0．18，95％CI（0．13，O．25），P〈O．00001]，增加术后嗜睡的发生[OR=0．14，95％C1（o．03，O．68），P=0．01]，但其他不良反应（包括支气管痉挛、呛咳、屏气、血氧饱和度下降）的发生情况两组无差异，右美托咪定也能降低麻醉恢复期间小儿的平均动脉压和心率。但应用右美托咪定会延长小儿七氟醚麻醉的苏醒时间[MD=2．14，95％CI（0．95，3．33），P=O．0004]、拔管（或移除喉罩）时间[MD=I．26，95％CI（O．51，2．00），P=0．0009]及PACU停留时间[MD=4．72，95％（2．07，7．38），P=0．0005o结论右美托咪定能降低小儿七氟醚全麻恢复期间躁动的发生率，且有利于维持麻醉恢复期间血流动力学的稳定，但会延长全麻后苏醒时间、拔管（或移除喉罩）时间、PACU停留时间，也会增加术后嗜睡的发生率。

Dexmedetomidine in Pediatric Patients during the Recovery Period after Sevoflurane-Based General Anesthesia: A Meta-Analysis

Objective To assess the influence of dexmedetomidine on the recovery of pediatric patients after sevo- flurane anesthesia. Methods Such databases as PubMed （1966 to March 2012）, The Cochrane Library （Issue 1, 2012）, EBSCO （ASP） （1984 to March 2012）, Journals@Ovid Full Text （1993 to March 2012）, CBM （1978 to March 2012）, CNKI （1979 to March 2012）, VIP （1989 to March 2012）, and WanFang Data （1998 to March 2012） were searched to collect ran- domized controlled trials （RCTs） about the influence of dexmedetomidine on the recovery of pediatric patients after sevo- flurane anesthesia, and the references of the included studies were also retrieved. Two researchers extracted the data and evaluated the methodological quality of the included studies independently. Then the RevMan 5.2 software was used for meta-analysis. Results A total of 16 RCTs involving 1 217 patients were included. The results of meta-analysis showed that, compared with the placebo, dexmedetomidine could reduce the occurrence of emergence agitation （OR=0.18, 95%CI 0.13 to 0.25, P〈0.000 01） and increase the occurrence of postoperative lethargy （OR=0.14, 95%CI 0.03 to 0.68, P=0.01）, but there were no differences in the occurrence of side effects including bronchospasm, bucking, breathholding, and oxygen desaturation. Dexmedetomidine could also reduce mean arterial blood pressure （MAP） and heart rate （HR） of pediatric patients during the recovery period after sevoflurane anesthesia, but it increased emergence time （MD=2.14, 95%CI 0.95 to 3.33, P=0.000 4）, extubation time （MD=l.26, 95%CI 0.51 to 2.00, P=0.000 9） and the time of staying in PACU （MD=4.72, 95%CI 2.07 to 7.38, P=0.000 5）. Conclusions For pediatric patients recovering from sevoflurane-based general anes- thesia, dexmedetomidine can reduce the occurrence of emergence agitation, and is helpful to maintain the hemodynamic balance. But it prolongs emergence time, extubation time （or the time of using the laryngeal mask） and the time of staying in PACU, and increases the occurrence of postoperative lethargy.