不同药物预防全身麻醉后寒战效能的Meta分析

发布时间：2018-04-22 09:13

本文选题：药物 + 全身麻醉　；参考：《广州医科大学》2014年硕士论文

【摘要】：目的:通过Meta分析的方法评价各种药物在预防全身麻醉后寒战方面的效能" 方法:以“drug, general anesthesia and shiver or rigor”为检索词检索PubMed、Springer、Sciencedirect、Ovid数据库，以“药物、全身麻醉、寒战”为检索词检索维普期刊全文数据库、万方数据库、中国期刊网（CNKI）、中国生物医学文献数据库（CBM），检索时间截止至2014年2月，限中英文语种，并手动或计算机检索相关杂志。根据需要制定严格的文献纳入标准和文献剔除标准，纳入所有药物预防全身麻醉后寒战方面的随机对照试验,对获得2篇以上相关措施的全文文献进行Meta分析。纳入研究的质量评价方法采用修正后的Jadad评分量表和随机分配隐藏方案,两名独立人员提取相关资料和数据,并绘制表格。采用Revman5.2软件对寒战发生情况进行数据处理和分析,结果采用优势比(odds ratio, OR)和95%可信区间(confidence interval, el)表示,并绘制森林图(forest plot)。以I40%和P0.1作为检验异质性(heterogeneity)的统计量标准。绘制漏斗图(funnel plot)和计算失安全系数(fale-safe number,Nfs)来评估结果是否受发表偏倚的影响,并根据各纳入文献的特征对结果进行敏感性分析。结果:共有39篇文献最终确定进入本文作为Meta分析原始数据。其中右美托咪定11篇、可乐定4篇；中枢性兴奋药多杀普伦2篇；曲马多8篇，帕瑞昔布钠3篇，奈福泮、地佐辛各2篇，地塞米松、地西拉嗪、替扎尼定、芬太尼、哌替啶、氯胺酮、欧贝各1篇,纳入的文献方法学质量相对较高。对各药物获得2篇以上全文文献,分别进行Meta分析,共计26篇。整体分析的结果显示,帕瑞昔布钠、曲马多、右美托咪定、可乐定均可有效降低全身麻醉后寒战的发生。结果分别为(p0.005,OR=0.14,95%CI为0.04-0.54)、(p0.00001,OR=0.13,95%CI为0.08-0.22)，（p 0.00001,OR=0.13,95%CI为0.09-0.21）。对纳入的研究按照干预时间的不同进行亚组分析，结果表明曲马多在术毕、麻醉诱导前给予对全身麻醉后寒战的预防均有效，，结果分别为（p=0.0003,OR=0.16,95%CI为0.06-0.44， p=0.69， I=0%；p0.00001,OR=0.04,95%CI为0.01-0.13，p=0.4，I=0%)，对所纳入研究按照干预措施的不同进行亚组分析，结果表明，右美托咪定在手术结束前30min给予，麻醉诱导前单次给予，麻醉诱导前单次给予复合剂量并持续给予麻醉维持对全身麻醉后寒战的预防均有效，结果分别为（p0.00001,OR=0.10,95%CI为0.04-0.28，p=0.54，I=0%；p=0.0007,OR=0.07,95%CI为0.01-0.32，p=0.46，I=0%；p0.00001, OR=0.17,95%CI为0.08-0.34，p=0.70，I=0%）。结论：帕瑞昔布钠、曲马多、右美托咪定、可乐定均可有效降低全身麻醉后寒战的发生。
[Abstract]:Objective: to evaluate the efficacy of various drugs in preventing shivering after general anesthesia by means of Meta analysis. Methods: using "general, general anesthesia and shiver or rigor" as the key word to search the database of PubMeder Spring Science Direction Ovid, using "drugs, General Anesthesia, shivering" as the key word to search the full text database of Weip journal and the database of Wancang, and to search the database of "drug, general anesthesia, shivering" as the key word. CNKI, China Biomedical Literature Database (CBM). The search time is up to February 2014. The search time is limited to Chinese and English languages, and related journals are searched manually or by computer. According to the need to establish strict standards of literature inclusion and elimination, to include all drugs in the prevention of cold after general anesthesia randomized controlled trial, to obtain more than two related measures of the full text of the Meta analysis. The quality evaluation method included in the study was a modified Jadad rating scale and a random allocation scheme. Two independent personnel extracted the relevant data and data and drew the table. Revman5.2 software was used to process and analyze the occurrence of shivering. The results were expressed by odds odds ratio (OR) and 95% confidence confidence interval.forest maps were plotted. I 40% and P 0. 1 were used as statistical criteria to test heterogeneity. Funnel plotand fale-safe number Nfs) were used to evaluate whether the results were affected by publication bias, and the sensitivity of the results was analyzed according to the characteristics of the literatures involved. Results: a total of 39 articles were finally identified as raw data for Meta analysis in this paper. Of these, 11 were dexmetomidine, 4 clonidine; 2 were central stimulators, 8 were tramadol, 3 were paroxib sodium, 2 were nafopam, 2 were diazoside, 2 were dexamethasone, diceprazine, tezanidine, fentanyl, pethidine, Ketamine, Obeb, 1 each, included a relatively high quality of literature methodology. More than 2 articles were obtained from each drug, and 26 articles were analyzed by Meta. Overall analysis showed that paroxib sodium tramadol dexmetomidine and clonidine could significantly reduce the incidence of shivering after general anesthesia. The results were as follows: 0.1495 CI (0.04-0.54) and 0.1395 CI (0.08-0.22). The CI values were 0.09-0.21 (P 0.00001) and 0.09-0.21 (CI = 0.09-0.21) respectively. The subgroup analysis of the included study according to the time of intervention showed that tramadol was effective in preventing shivering after general anesthesia at the end of operation and before induction of anesthesia. The results showed that the CI was 0.06-0.44, p0.69, and 0.01-0.13 respectively. The CI was 0.01-0.13, and the CI was 0.01-0.13. The subgroup analysis was carried out according to the intervention measures. The results showed that dexmetomidine was given only once before anesthesia induction. A single dose of compound dose before induction and continuous maintenance of anesthesia were effective for the prevention of shivering after general anesthesia. The results were as follows: 0.1095 CI was 0.04-0.28p0.54I0, and the CI was 0.01-0.32p0.46I00.001, and 0.1795CI was 0.08-0.34p0.701. Conclusion: pareoxib sodium, tramadol, dexmetomidine and clonidine can effectively reduce the incidence of shivering after general anesthesia.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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