摘要
目的评价椎管内辅助右美托咪定对预防蛛网膜下腔麻醉(以下简称腰麻)剖宫产术后寒战的有效性和安全性.方法检索PubMed、Embase、Cochrane临床试验数据库、中国生物医学文献数据库、中国期刊网全文数据库和万方数据库,结合手工查找相关文献的参考文献,收集关于椎管内辅助右美托咪定对预防腰麻剖宫产术后寒战的随机对照试验,检索时间从建库至2017年6月,无语种限制.两位评价者独立评价每项研究的质量并提取数据,采用Review Manager 5.3软件进行Meta分析.结果共纳入8篇文献,570例患者,其中右美托咪定组286例,对照组284例.Meta分析结果显示,与生理盐水组比较,右美托咪定组寒战发生率低于对照组(OR =0.19,95% CI:0.12 ~0.30,P=0.000),能明显缩短椎管内麻醉感觉阻滞起效的平均时间(WMD=-2.29,95%CI:-4.49^-0.08)和运动阻滞起效的平均时间(WMD=-0.99,95%CI:-1.20^-0.78),并延长感觉阻滞消退的平均时间(WMD =52.42,95% CI:38.69~66.15)和运动阻滞消退的平均时间(WMD=38.05,95%CI:11.61~64.49),差异有统计学意义;但在心动过缓、低血压、术后恶心呕吐、瘙痒的发生率以及新生儿1min和5min Apgar评分、脐静脉血pH值方面比较,差异无统计学意义.结论右美托咪定椎管内辅助给药能降低腰麻剖宫产术后寒战的发生率,缩短感觉和运动阻滞起效时间,延长其作用时间,不增加低血压、心动过缓等不良反应发生率,且对新生儿预后无不良影响.
Objective To evaluate he efficacy and safety of intrathecal dexmedetomidine in prevention of shivering after spinal anesthesia for cesarean section. Methods The authors searched the PubMed Embase, Cochrane Library, CBM , CNKI and Wanfang databases for all the randomized controlled trials( RCTs) about intrathecal dexmedetomidine in prevention of shivering after spinal anesthesia for cesarean section from inception to June 2017 without language or date restrictions. Two reviewers independently assessed the quality of every references and extracted useful data and then conducted the Meta analysis with RevMan5. 3 software. Results A total of 570 patients were included in 8 literatures, including 286 in dexmedetomidine group and 284 in control group. Meta analysis results show that compared with normal saline group, the incidence of shivering in dexmedetomidine group was lower than that in control group ( OR = 0. 19 , 95% CI :0. 12 - 0. 30, P = 0. 0000 ), which can significantly shorten the average onset time of sensory block in spinal anesthesia (WMD =- 2. 29 , 95% CI:- 4. 49 -- 0. 08) and motor blockade effect to the average time ( WMD = 0. 99, 95% CI : 1.20 - 0. 78 ), and prolong the average sensory blockade fade ( WMD = 52. 42 , 95% CI :38. 69 - 66. 15 ) and the mean time of motor block resolution (WMD =38.05, 95% CI : 11.61 -64.49), and the difference was statistically significant. However, there was no statistically significant difference in the incidence of bradycardia, hypotension, postoperative nausea, vomiting and pruritus, Apgar score at 1 min and 5min , and pH of umbilical venous blood between the two groups. Conclusion Dexmedetomidine assisted intrathecal administration can reduce the shivering rate of spinal anesthesia for cesarean section, shorten the onset time of sensory and motor block as well as prolong the action time, but does not increase the hypotension, bradycardia and incidence of side effects and also not affect neonatal prognosis.
作者
汤冰冰
李亚鹏
陈捷
刘功俭
Tang Bingbing;Li Yapeng;Chen Jie(Xuzhou Medical University , Jiangsu 221004, China)
出处
《医学研究杂志》
2019年第6期138-144,130,共8页
Journal of Medical Research
关键词
右美托咪定
椎管内麻醉
剖宫产
寒战
META分析
Dexmedetomidine
Intravertebral anesthesia
Caesarean section
Shivering
Meta - analysis
