比较右美托咪定与曲马多预防围术期寒战效果的Meta分析

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (2588 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：分析右美托咪定与曲马多预防围术期寒战的效果以及不良反应发生情况。方法：检索万方数据库、中国知网等中文数据库及Pubmed、Medline等外文数据库，收集2010年1月至2014年6月有关右美托咪定与曲马多预防围术期寒战效果比较的临床随机对照试验。根据Cochrane系统评价手册5.0对纳入研究的文献进行质量评价。在RevMan5.1软件中对相应的研究指标进行Meta分析。结果：有14篇文献进入了本次Meta分析，共854例患者。疗效方面：右美托咪定预防围术期寒战的效果均显著优于曲马多（RR=0.60，95%CI：0.41～0.88，P=0.008)。不良反应方面：右美托咪定组恶心、呕吐的发生率显著低于曲马多组（RR=0.07，95%CI：0.03～0.14，P＜0.00001），头晕发生率显著低于曲马多组（RR=0.28，95%CI：0.11～0.73，P=0.01）。漏斗图表明各项指标未有显著性发表偏倚。结论：右美托咪定预防围术期寒战的效果优于曲马多，恶心、呕吐等不良反应的发生率较曲马多明显降低。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	赵喜越1
	缪剑霞1
	王良荣1
	蒋柳明1
	邱恩毅2
	林丽娜1

关键词 ：右美托咪定, 曲马多, 围术期寒战, Meta分析

Abstract：Objective: To compare the effects of dexmedetomidine and tramadol in prevention of perioperative shivering and evaluate their side effects. Methods: All the randomized controlled trials referring to the comparison of dexmedetomidine and tramadol in prevention of perioperative shivering were searched in the domestic and foreign databases in recent five years. The enrolled published literatures were analyzed using Meta-analysis method with RevMan5.1 statistical analysis software. Results: Fourteen separate clinical randomized controlled trials including 854 cases were researched with the Meta-analysis. Objective responsiveness: the perioperative shivering rates of dexmedetomidine group were less than that of tramadol group (P=0.008). The RR values and 95%CI (confidence interval) were 0.60 (0.41~0.88). Adverse reactions: the incidence of nauses and vomiting were lower in the dexmedetomidine group than that in the tramadol group (P=0.008), the RR and 95%CI were 0.07 (0.03~0.14). The incidence of dizziness were lower in the dexmedetomidine group than that in the tramadol group (P=0.01), the RR and 95%CI were 0.28 (0.11~0.73). The funnel plots showed no significant publication bias in each indexes. Conclusion: The roles of prevention of perioperative shivering in dexmedetomidine group are superior to tramadol group. The incidence of adverse reactions are less in the dexmedetomidine group than that in the tramadol group.

Key words： dexmedetomidine tramadol perioperative shivering Meta-analysis

收稿日期: 2014-08-31

通讯作者: 林丽娜，主任医师，教授，硕士生导师，Email：9088 64101@qq.com。

作者简介: 赵喜越（1981-），女，浙江温州人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2014/V44/I12/896

[1]Mohta M, Kumari N, Tyagi A, et al. Tramadol for prevention of postanaesthetic shivering:a randomised doubleblind comparison with pethidine[J]. Anaesthesia, 2009, 64(2): 141-146.
[2]朱凡, 赵欣, 诸燕, 等. 术前应用曲马多对其术后镇痛效果和恶心呕吐的影响[J]. 临床麻醉学杂志, 2008, 24(2): 165-166.
[3]Bajwa SJ, Gupta S, Kaur J, et al. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study[J]. J Anaesthesiology Clin Pharmacol, 2012, 28(1): 86-91.
[4]Bozgeyik S, Mizrak A, Kılıç E, et al. The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy[J]. Saudi J Anaesthesia, 2014, 8(2): 238-243.
[5]严江, 区锦燕, 陈寰. 右美托咪定治疗全身麻醉后重度寒战效果观察[J]. 海南医学, 2011, 22(16): 16-18.
[6]刘颖. 右美托咪定和曲马多在椎管内麻醉阑尾切除术中预防寒战的临床分析[J]. 中国临床研究, 2012, 25(2): 152-153.
[7]吴伟华, 蓝建良, 叶志敞, 等. 右美托咪定和曲马多治疗椎管内麻醉后寒颤效果的比较[J]. 浙江创伤外科, 2013, 18(3): 443-444.
[8]宿颖岚, 袁谦, 李亚丽. 右美托咪定预防经皮肾穿刺碎石取石术中寒战的效果观察[J]. 黑龙江医药, 2013, 26(1): 134-136.
[9]徐伟, 夏瑞, 郑吉卫, 等. 右美托咪定与曲马多预防腰麻后寒战作用的比较[J]. 重庆医学, 2011, 40(29): 2977-2979.
[10]李静, 黄德樱, 向强. 右美托咪定与曲马多治疗剖宫产术中寒战的对比研究[J]. 心理医生, 2012, 214(4): 323-324.
[11]林芩, 钱彬. 右美托咪定和曲马多治疗术后寒战效果的比较[J]. 临床麻醉学杂志, 2011, 27(5): 473-474.
[12]梁勤敏. 右美托咪定与曲马多静脉注射用于治疗术后寒战的疗效比较[J]. 现代养生, 2013(12): 152.
[13]王志强. 右美托咪定与曲马多在全麻手术中预防寒战作用的比较[J]. 中国医药指南, 2013, 11(4): 581-582.
[14]珠娜. 右美托咪定与曲马多预防全麻手术后寒战的比较[D]. 沈阳: 中国医科大学, 2012.
[15]苏玉强, 范晓英. 右美托咪定、曲马多和酒石酸布托啡诺治疗腰-硬联合麻醉后剖宫产患者寒战效果比较[J]. 当代医学, 2013, 19(25): 135-136.
[16]蔡诚毅, 马武华, 王勇, 等. 右美托咪定预防椎管内麻醉后寒战[J]. 广东医学, 2012, 33(4): 543-544.
[17]韩智晓, 傅艳妮, 梁建军. 右美托咪定对经尿道前列腺切除术患者寒战发生的预防效果[J]. 岭南现代临床外科, 2012, 12(5): 277-279.
[18]De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology[J]. Anesthesiology, 2002, 96(2): 467-484.
[19]Piper SN, Rohm KD, Suttner SW, et al. A comparison of nefopam and clonidine for the prevention of postanesthetic shivering: A comparative, double blind and placebo controlled dose ranging study[J]. Anaesthesia, 2004, 59(6): 559-564.
[20]Akin A, Esmaoglu A, Boyaci A. Postoperative shivering in children and causative factors[J]. Paediatr Anaesth, 2005,15(12): 1089-1093.
[21]Eberhart LH, Daderlein F, Eisenhardt G, et a1. Independent risk factors for postoperative shivering[J]. Anesth Analg, 2005, 101(6): 849-1 857.
[22]曹建平, 徐建国. 曲马多和哌替定用于全麻后寒战的预防[J]. 中华麻醉学杂志, 2003, 23(3): 220-221.
[23]Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group[J]. New Engl J Med, 1996, 334(19): 1209-1215.
[24]Kranke P, Eberhart LH, Roewer N, et al. Single dose parenteral pharmacological interventions for the prevention of postoperative shivering: A quantitative systematic review of randomized controlled trials[J]. Anesth Analg, 2004, 99(3): 718-727.
[25]Bicer C, Esmaoglu A, Alkin A, et a1. Dexmedetomidine and meperidine prevent postanaesthetic shivering[J]. Eur J Anaesth, 2006, 23(2): 149-153.
[26]曾朝坤, 王彪, 徐康清, 等. 布托啡诺与曲马多治疗妇科手术腰硬联合麻醉后寒战的效果比较[J]. 临床医学, 2010, 30(3): 29-30.
[27]Mathews S, Mulla A, Varghese PK, et a1. Postanaesthetic shivering a new look at tramadol[J]. Anaesthesia, 2002, 57(4): 394-398.
[28]Heid F, Grimm U, Roth W, et a1. Intraoperative tramadol reduces shivering but not pain after remifentanil-isoflurane general anaesthesia. A placebo-controlled, double-blind trial[J]. Eur J Anaesthesiol, 2008, 25(6): 468-472.
[29]中华医学会麻醉学分会. 右美托咪定临床应用指导意见[J]. 中华麻醉学杂志, 2013, 33(10): 1165-1167.
[30]Herr DL, Sum-Ping ST, England M. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens[J]. Cardiothorac Vasc Anesth, 2003, 17(5): 576-584.
[31]Tobias JD. Bradycardia during dexmedetomidine and thera-peutic hypothemia[J]. J Intensive Care Med, 2008, 23(6):403-408.
[32]Venn RM, Bryant A, Hall GM, et al. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory response in post-operative patients needing sedation in the intensive care unit[J]. Br J Anaesth, 2001, 86(5): 650-656.
[33]陈忠华, 蒋宗明, 陈念, 等. 右美托咪定辅助麻醉下肺癌根治术病人麻醉后寒战的发生[J]. 中华麻醉学杂志, 2011, 31(10): 1217-1219.
[34]陈磊, 陈丹, 林丽娜, 等. 右美托咪啶用于门诊宫腔镜手术的有效性及安全性[J]. 温州医学院学报, 2012, 42(4): 335-338.