Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: A meta-analysis of randomized controlled trials
Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: A meta-analysis of randomized controlled trials
复制标题
静脉注射右美托咪定与成年患者择期手术后的恢复质量：随机对照试验的荟萃分析
DOI：
10.1016/j.jclinane.2020.109849
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发表时间：
2020-10-01
影响因子：
6.7
通讯作者：
Zhang, Jiaqiang
中科院分区：
文献类型：
--
作者：
Miao, Mengrong;Xu, Yuehua;Zhang, Jiaqiang
研究目的：评价术前和围手术期静脉注射右美托咪定提高恢复质量的有效性和安全性（通过40项恢复质量问卷（QoR-40）测量，范围从40到200）。设计：荟萃分析。设置：接受择期手术的成人患者。干预：术前和围手术期静脉注射右美托咪定。测量：主要结局是术后恢复质量。次要结局是右美托咪定相关不良事件的发生率。主要结果：中到低质量证据表明，右美托咪定（DEX）提高了术后恢复质量（WMD，加权平均差15.71，95%CI，置信区间0.43 - 31.00; 428名受试者; 5项RCT;低质量证据），降低术后恶心或呕吐的发生率（RR，风险比0.60，95% CI 0.44 - 0.83; 404例受试者; 6项RCT;中等质量证据; RR 0.32，95% CI 0.19 - 0.55; 356例受试者; 5项RCT;中等质量证据），而不会增加心动过缓的风险（RR：1.78，95% CI 0.78 - 4.02; 275例受试者; 4项RCT;中等质量证据），头晕（RR 0.78，95% CI 0.31 - 2.00; 183例受试者; 3项RCT;中等质量证据），瘙痒（RR 1.32，95% CI 0.39 - 4.44; 186例受试者; 3项RCT;中等质量证据），需要干预的低血压（RR：1.48，95% CI，0.68 - 3.23; 254例受试者; 3项RCT;中等质量证据）和住院时间更长（WMD：-0.75天，95% CI -1.95至0.44; 246名参与者; 3项RCT;低质量证据）。右美托咪定作为全身麻醉的麻醉辅助剂与恢复质量的提高（15.71;远高于临床显著改善6.3）相关，而术后早期不良事件风险未增加（中至低质量证据）。需要进一步的大样本和高质量的随机对照试验来证实目前的研究结果。
Study objective: To evaluate the efficacy and safety of pre- and perioperative intravenous administration of dexmedetomidine for enhancing quality of recovery (as measured by 40-item quality of recovery questionnaire (QoR-40), ranged from 40 to 200) after surgery.Design: Meta-analysis.Setting: Adult patients undergoing elective surgery.Intervention: Intravenous administration of dexmedetomidine during pre- and perioperative period.Measurements: The primary outcome was quality of recovery after surgery. The secondary outcome was the incidence of dexmedetomidine-related adverse events.Main results: Moderate to low quality evidence suggested that dexmedetomidine (DEX) increased the quality of recovery after surgery (WMD, weighted mean difference 15.71, 95% CI, confidence interval 0.43 to 31.00; 428 participants; 5 RCTs; low quality evidence), decreased the incidence of postoperative nauseas or vomiting (RR, risk ratio 0.60, 95% CI 0.44 to 0.83; 404 participants; 6 RCTs; moderate quality evidence; RR 0.32, 95% CI 0.19 to 0.55; 356 participants; 5 RCTs; moderate quality evidence) without increased risk of bradycardia (RR: 1.78, 95% CI 0.78 to 4.02; 275 participants; 4 RCTs; moderate quality evidence), dizziness (RR 0.78, 95% CI 0.31 to 2.00; 183 participants; 3 RCTs; moderate quality evidence), pruritus (RR 1.32, 95% CI 0.39 to 4.44; 186 participants; 3 RCTs; moderate quality evidence), hypotension requiring an intervention (RR: 1.48, 95% CI, 0.68 to 3.23; 254 participants; 3 RCTs; moderate quality evidence) and longer length of hospital stay (WMD: - 0.75 days, 95% CI -1.95 to 0.44; 246 participants; 3 RCTs; low quality evidence) in early postoperative period.Conclusions: Dexmedetomidine as an anesthetic adjuvant to general anesthesia was associated with an enhanced quality of recovery (15.71; far more than a clinically significant improvement of 6.3) without increased risk of adverse events in the early postoperative period (moderate to low quality evidence). Further large sample and high quality RCTs are needed to confirm the current findings.