盐酸右美托咪定对胸科手术单肺通气肺内分流影响的meta分析

发布时间：2018-11-23 12:53

【摘要】：背景:右美托咪定因具有抑制应激反应、维持血流动力学稳定、无呼吸抑制作用等优点,被越来越广泛的用于ICU镇静及围术期麻醉的辅助用药。目前在单肺通气(OLV)的胸科手术中使用盐酸右美托咪定辅助麻醉是否会对肺内分流(Qs/Qt)产生影响仍有争议。目的:通过Meta分析研究单肺通气的胸科手术麻醉期间使用盐酸右美托咪定是否对患者肺内分流产生影响,为盐酸右美托咪定应用于单肺通气胸科手术提供理论依据。方法:通过计算机检索PubMed、The Cochrane Library、Embase、中国生物医学文献、中国知网、维普中文科技期刊、万方医学网等数据库,并利用百度和Google搜索工具检索其它的资料,查找出所有有关盐酸右美托咪定应用于单肺通气胸科手术患者是否会对肺内分流产生影响的随机对照试验(RCT)文献,同时对纳入文献的参考文献进行检索。对纳入的文献进行质量评价及资料提取,并采用RevMan 5.3对各研究指标进行Meta分析。结果:共纳入18个RCT,共计846例患者,其中盐酸右美托咪定组444例,对照组402例。Meta分析结果显示,盐酸右美托咪定组(D组)与生理盐水组(N组)在单肺通气10min的Qs/Qt[WMD=-7.47,95%CI(-9.63~-5.30),p0.00001]、单肺通气15min的Qs/Qt[WMD=-5.00,95%CI(-8.83~-1.17),p=0.01]、单肺通气30min的Qs/Qt[WMD=-4.02,95%CI(-6.19~-1.85),p=0.0003]、单肺通气40min的Qs/Qt[WMD=-3.13,95%CI(-5.47~-0.79),p=0.009]及单肺通气60min的Qs/Qt[WMD=-3.23,95%CI(-5.23~-1.22),p=0.002]差异有统计学意义,在单肺通气90min时的Qs/Qt[WMD=-1.54,95%CI(-3.30~0.23),p=0.09]差异无统计学意义。结论:单肺通气胸科手术麻醉中经静脉使用盐酸右美托咪定,可以在一定程度上减少单肺通气期间的肺内分流率,有利于预防单肺通气期间因肺内分流过大导致的低氧血症。
[Abstract]:Background: dexmetidine has been widely used in ICU sedation and perioperative anesthesia because of its advantages of inhibiting stress response maintaining hemodynamic stability and no respiratory inhibition. Whether dexmetidine hydrochloride can affect intrapulmonary shunt (Qs/Qt) in thoracic surgery of single lung ventilation (OLV) is still controversial. Objective: to study the effects of dexmetidine hydrochloride on intrapulmonary shunt in patients undergoing single lung ventilation during chest surgery by Meta analysis, and to provide a theoretical basis for the application of dexmetidine hydrochloride in single lung ventilation chest surgery. Methods: PubMed,The Cochrane Library,Embase, Chinese biomedical literature, Chinese knowledge network, Weipu Chinese science and technology journal, Wanfang medical net and other databases were searched by computer, and other data were retrieved by Baidu and Google search tools. To find out all the randomized controlled trial (RCT) literatures about the effect of dexmetidine hydrochloride on intrapulmonary shunt in patients undergoing single lung ventilation and chest surgery, and to search the references included in the literature. The quality evaluation and data extraction of the included literature were carried out, and the Meta analysis of each research index was carried out by RevMan 5.3. Results: a total of 846 patients with RCT, were included, including 444 patients in dexmetomidine hydrochloride group and 402 patients in control group. The results of Meta analysis showed that, Dexmetidine hydrochloride group (group D) and saline group (group N) were treated with Qs/Qt [WMD=-7.47,95%CI (-9.63 ~ -5.30), p 0.00001] in one-lung ventilation 10min. Qs/Qt of one-lung ventilation 15min [WMD=-5.00,95%CI (-8.83 ~ 1.17), p0.01], Qs/Qt of one-lung ventilation 30min [WMD=-4.02,95%CI (-6.19 ~ -1.85), p _ (0.0003)], There were significant differences in Qs/Qt [WMD=-3.13,95%CI (-5.47) -0.79), p0. 009] in 40min and Qs/Qt [WMD=-3.23,95%CI (-5.23-1.22), p0. 002] in single lung ventilation 60min. There was no significant difference in Qs/Qt [WMD=-1.54,95%CI (- 3. 30 卤0. 23), p0. 09] during single lung ventilation with 90min. Conclusion: intravenous administration of dexmetidine hydrochloride in one-lung ventilation chest surgery anesthesia can reduce intrapulmonary shunt rate in a certain extent and is helpful to prevent hypoxemia caused by excessive intrapulmonary shunt during single-lung ventilation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

【参考文献】