右美托咪定在小儿气管异物取出术中的应用安全性评价

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摘要目的：系统评价右美托咪定在小儿气道异物取出术中应用的安全性。方法：计算机检索Cochrane图书馆、MEDLINE、CNKI、VIP及CBM（从建库至2016年3月），收集所有右美托咪定在小儿气管异物取出术中应用的随机对照试验（RCT），使用Cochrane系统评价方法进行质量评价，并采用RevMan 5.0软件进行Meta分析。结果：共纳入4个RCT，包括227例患者。Meta分析结果显示：①右美托咪定与其他组比较能明显减少呛咳发生率（OR=0.44，95%CI：0.21～0.92，P＜0.05）；②右美托咪定与其他组比较能明显降低气道痉挛发生率（OR=0.21，95%CI：0.05～0.86，P＜0.05）；③右美托咪定与其他组比较屏气发生率差异无统计学意义（OR=0.50，95%CI：0.22～1.14，P＞0.05）；④右美托咪定与其他组比较能明显降低低氧血症发生率（OR=0.44，95%CI：0.21～0.92，P＜0.05）。结论：右美托咪定能有效减少小儿气管异物取出术中的呼吸系统不良事件（呛咳、气道痉挛、屏气及低氧血症）发生率。但限于纳入研究方法学质量上的局限性，本系统评价结果尚需更多高质量的RCT进一步验证。

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关键词 ：右美托咪定, 小儿, 支气管镜, 随机对照试验, Meta分析

Abstract：Objective: To evaluate the safety of dexmedetomidine on pediatric patients undergoing removal of airway foreign body. Methods: Randomized controlled trials (RCTs) about the pediatric patients undergoning removal of airway foreign body receiving intravenous infusion of dexmedetomidine were searched in The Cochrane Library, Medline, CNKI, VIP, CBM up to March 2016. The methodological quality of the included literatures were evaluated, and meta-analyses were performed with The Cochrane Collaboration’s RevMan 5.0 software. Results: A total of 4 RCTs involving 227 pediatric patients were included. The results of meta-analyses showed: ①Dexmedetomidine significantly reduced the coughing ratio (OR=0.44, 95%CI: 0.21-0.92, P<0.05); ②Dexmedetomidine significantly reduced the airway-spasm ratio (OR=0.21, 95%CI: 0.05-0.86, P<0.05); ③Dexmedetomidine did not significantly reduce the breath holding ratio (OR=0.50, 95%CI: 0.22-1.14, P>0.05); ④Dexmedetomidine significantly reduced the airway-spasm ratio (OR=0.44, 95%CI: 0.21-0.92, P<0.05). Conclusion: Dexmedetomidine is a safe anesthestic for airway foreign body removal in children from general anesthesia, decreasing the perioperative respiratory adverse events (coughing, airway-spasm, hypoxemia). However, because of the limited quality of the included researchs, further verification with more high quality RCTs are needed.

Key words： dexmedetomidine paediatric bronchoscopy randomized controlled trial meta-analysis

收稿日期: 2017-02-21

基金资助:浙江省医药卫生平台骨干人才项目（2012ZDA036）。

作者简介: 黄葱葱（1983-），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/Y2017/V47/I10/758

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