右美托咪啶和丙泊酚对术后ICU患者镇静效果的系统评价

目的系统评价右美托咪啶和丙泊酚对术后ICU患者的镇静、镇痛效果和不良反应。方法计算机检索Cochrane Library、PubMed、SCI、SpringerLinker、ScinceDirect、CNKI、VIP、WanFang Data、CBM等数据库,检索时限均从建库至2011年11月,收集所有右美托咪啶和丙泊酚对术后ICU患者镇静镇痛效果的随机对照试验(RCT),由2位研究者对纳入研究进行资料提取和质量评价后,采用RevMan 5.1软件进行Meta分析。结果共纳入10个RCT,793例患者。定性分析结果显示,在一定剂量范围内[右美托嘧啶:0.2～2.5μg/(kg.h),丙泊酚:0.3～4.5 mg/(kg.h)],右美托嘧啶和丙泊酚提供治疗所需镇静效果相似。镇静治疗时,右美托咪啶组需追加的镇痛药剂量少于丙泊酚组。Meta分析结果显示:镇静治疗期间,右美托咪啶组需追加镇痛药的人数比例少于丙泊酚组[OR=0.24,95%CI(0.08,0.68),P=0.008];与丙泊酚相比,右美托咪啶能显著减少患者ICU入住时间[WMD=–1.10,95%CI(–1.88,–0.32),P=0.006],但不能减少患者机械通气时间[WMD=0.89,95%CI(–1.15,2.93),P=0.39];镇静治疗期间,两组患者不良反应(心动过缓及低血压)发生率差异无统计学意义[心动过缓OR=3.57,95%CI(0.86,14.75),P=0.08;低血压OR=1.00,95%CI(0.30,3.32),P=1.00];与右美托咪啶相比,丙泊酚可能更容易引起镇静期间的呼吸抑制,但该结果尚需进一步研究。镇静治疗后,两组患者病死率差异无统计学意义[OR=1.03,95%CI(0.54,1.99),P=0.92]。结论在一定剂量范围内,右美托咪啶具有与丙泊酚相似的镇静效果,兼有镇痛作用,可节约镇痛药用量,并可减少患者的ICU入住时间,且较少发生不良反应和呼吸抑制。鉴于本系统评价样本量有限,纳入研究质量不高,所得结论尚需开展更多设计严谨的大样本随机对照试验加以验证。

Sedative Effect of Dexmedetomidine versus Propofol on Postoperative Patients in ICU:A Systematic Review

Objective To evaluate the sedative and analgesic efficacy and adverse effect of dexmedetomidine versus propofol on the postoperative patients in intensive care unit(ICU).Methods The relevant randomized controlled trials(RCTs) were searched in The Cochrane Library,MEDLINE,PubMed,SCI,SpringerLinker,ScinceDirect,CNKI,VIP,WanFang Data and CBM from the date of their establishment to November 2011.The quality of the included studies was evaluated after the data were extracted by two reviewers independently,and then the meta-analysis was performed by using RevMan 5.1.Results Ten RCTs involoving 793 cases were included.The qualitative analysis results showed: within a certain range of dosage as dexmedetomidine: 0.2-2.5 μg/(kg·h),and propofol: 0.8-4 mg/(kg·h),dexmedetomidine was similar to propofol in sedative effect,but dexmedetomidine group needed smaller dosage of supplemental analgesics during the period of sedative therapy.The results of meta-analysis showed: the percentage of patients needing supplemental analgesics in dexmedetomidine group was less than that in propofol group during the period of sedative therapy(OR=0.24,95%CI 0.08 to 0.68,P=0.008).Compared with the propofol group,the duration of ICU stay was significantly shorter in the dexmedetomidine group(WMD= –1.10,95%CI –1.88 to –0.32,P=0.006),but the mechanical ventilated time was comparable between the two groups(WMD=0.89,95%CI –1.15 to 2.93,P=0.39);the incidence of adverse effects had no significant difference between two groups(bradycardia: OR=3.57,95%CI 0.86 to 14.75,P=0.08;hypotension: OR=1.00,95%CI 0.30 to 3.32,P=1.00);respiratory depression seemed to be more frequently in propofol group,which however needed further study.Mortalities were similar in both groups after the sedative therapy(OR=1.03,95%CI 0.54 to 1.99,P=0.92).Conclusion Within an exact range of dosage,dexmedetomidine is comparable with propofol in sedative effect.Besides,it has analgesic effect,fewer adverse effects and fewer occurrences of respiratory depression,and it can save the extra dosage of analgesics and shorten ICU stay.Still,more larger-sample,multi-center RCTs are needed to provide more evidence to support this outcome.