Gong Zheng, Ma Li, Zhong Yu-Lin, Li Jun, Lv Jing, Xie Yu-Bo
Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China.
Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China.
Exp Ther Med. 2017 May;13(5):2355-2361. doi: 10.3892/etm.2017.4227. Epub 2017 Mar 13.
Arrhythmias are the common complications following cardiac surgery and contribute to hemodynamic instability, cognitive impairment, thromboembolic events, and congestive heart failure. Prevention of atrial fibrillation following cardiac surgery reduces morbidity and among the many available preventive approaches dexmedetomidine shows many positive effects on cardiovascular stability. Even though many studies indicated the beneficial effects of dexmedetomidine, the power of the analysis and conclusion of these studies is rather weak due to relatively smaller number of patients in these studies. In the present meta-analysis, we included a large number of patients, both children and adults, undergoing cardiac surgery, to address the efficacy of dexmedetomidine. Several databases were searched to identify clinical studies comparing the efficacy of dexmedetomidine in myocardial protection in patients undergoing cardiac surgery. Cardiac function related parameters including heart rate, blood pressure, tachycardia, arrhthmias, and bradycardia were measured. In accordance with the selection criteria, a total of 18 studies published between 2003 and 2016, with a total of 19,225 patients were included in the present meta-analysis. Dosage of dexmedetomidine was in the range of 0.5-1 µg/kg body weight loading followed by continuous infusion at a rate of 0.2-0.7 µg/kg/h. Dexmedetomidine treatment was found to lower heart rate, systolic blood pressure, incidence of tachycardia and arrhythmias in both adult and pediatric patients, but elevated the risk of bradycardia. In conclusion, results of this meta-analysis indicate that dexmedetomidine is an efficacious cardioprotective drug in adults and children undergoing cardiac surgery.
心律失常是心脏手术后常见的并发症，可导致血流动力学不稳定、认知障碍、血栓栓塞事件和充血性心力衰竭。预防心脏手术后房颤可降低发病率，在众多可用的预防方法中，右美托咪定对心血管稳定性显示出许多积极作用。尽管许多研究表明了右美托咪定的有益效果，但由于这些研究中的患者数量相对较少，其分析和结论的说服力相当薄弱。在本荟萃分析中，我们纳入了大量接受心脏手术的儿童和成人患者，以探讨右美托咪定的疗效。检索了几个数据库，以确定比较右美托咪定在心脏手术患者心肌保护方面疗效的临床研究。测量了包括心率、血压、心动过速、心律失常和心动过缓在内的与心功能相关的参数。根据选择标准，本荟萃分析共纳入了2003年至2016年发表的18项研究，共计19225例患者。右美托咪定的剂量范围为负荷剂量0.5 - 1μg/kg体重，随后以0.2 - 0.7μg/kg/h的速率持续输注。结果发现，右美托咪定治疗可降低成人和儿童患者的心率、收缩压、心动过速和心律失常的发生率，但会增加心动过缓的风险。总之，本荟萃分析结果表明，右美托咪定对接受心脏手术的成人和儿童是一种有效的心脏保护药物。
