右美托咪定对单肺通气患者肺功能的影响:一项随机对照试验的meta分析。

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Korean Journal of Anesthesiology Pub Date : 2023-12-01 Epub Date: 2023-03-16 DOI:10.4097/kja.22787
Lin Yang, Yongheng Cai, Lin Dan, He Huang, Bing Chen
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引用次数: 0

摘要

背景:机械通气,特别是单肺通气(OLV)可引起肺功能障碍。本荟萃分析评估了右美托咪定对OLV患者肺功能的影响。方法:系统检索Embase、PubMed、MEDLINE、Cochrane Library、ClinicalTrials.gov和Chinese ClinicalTrial Registry数据库。主要终点为氧合指数(OI)。评估其他结果,包括术后并发症的发生率。结果:本荟萃分析纳入了14项随机对照试验,涉及845例患者。右美托咪定改善了OLV术后30分钟(平均差值[MD]: 40.49, 95% CI[10.21, 70.78])、60分钟(MD: 60.86, 95% CI[35.81, 85.92])、90分钟(MD: 55, 95% CI[34.89, 75.11])和术后90分钟(MD: 28.98, 95% CI[17.94, 40.0])的OI,改善了OLV术后90分钟的肺顺应性(MD: 3.62, 95% CI[1.7, 5.53])。此外,右美托咪定降低了术后肺部并发症的发生率(优势比:0.44,95% CI[0.24, 0.82])和住院时间(优势比:-0.99,95% CI [-1.25, -0.73]);肿瘤坏死因子-α、白细胞介素(IL)-6、IL-8和丙二醛水平降低;增加了超氧化物歧化酶水平。然而,只有OI和IL-6水平的结果通过敏感性和试验序列分析得到证实。结论:右美托咪定改善OLV患者氧合,降低术后肺部并发症发生率,缩短住院时间,可能与肺顺应性改善、抗炎作用及氧化应激反应调节有关。然而,需要强有力的证据来证实这些结论。
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Effects of dexmedetomidine on pulmonary function in patients receiving one-lung ventilation: a meta-analysis of randomized controlled trial.

Background: Mechanical ventilation, particularly one-lung ventilation (OLV), can cause pulmonary dysfunction. This meta-analysis assessed the effects of dexmedetomidine on the pulmonary function of patients receiving OLV.

Methods: The Embase, PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, and Chinese Clinical Trial Registry databases were systematically searched. The primary outcome was oxygenation index (OI). Other outcomes including the incidence of postoperative complications were assessed.

Results: Fourteen randomized controlled trials involving 845 patients were included in this meta-analysis. Dexmedetomidine improved the OI at 30 (mean difference [MD]: 40.49, 95% CI [10.21, 70.78]), 60 (MD: 60.86, 95% CI [35.81, 85.92]), and 90 min (MD: 55, 95% CI [34.89, 75.11]) after OLV and after surgery (MD: 28.98, 95% CI [17.94, 40.0]) and improved lung compliance 90 min after OLV (MD: 3.62, 95% CI [1.7, 5.53]). Additionally, dexmedetomidine reduced the incidence of postoperative pulmonary complications (odds ratio: 0.44, 95% CI [0.24, 0.82]) and length of hospital stay (MD: -0.99, 95% CI [-1.25, -0.73]); decreased tumor necrosis factor-α, interleukin (IL)-6, IL-8, and malondialdehyde levels; and increased superoxide dismutase levels. However, only the results for the OI and IL-6 levels were confirmed by the sensitivity and trial sequential analyses.

Conclusions: Dexmedetomidine improves oxygenation in patients receiving OLV and may additionally decrease the incidence of postoperative pulmonary complications and shorten the length of hospital stay, which may be related to associated improvements in lung compliance, anti-inflammatory effects, and regulation of oxidative stress reactions. However, robust evidence is required to confirm these conclusions.

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来源期刊
CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
期刊最新文献
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