Huang Su-Qin, Zhang Jian, Zhang Xiong-Xin, Liu Lu, Yu Yang, Kang Xian-Hui, Wu Xiao-Min, Zhu Sheng-Mei
Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, China.
Department of Anesthesiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China.
Chin Med J (Engl). 2017 Jul 20;130(14):1707-1714. doi: 10.4103/0366-6999.209891.
One-lung ventilation (OLV) is a common ventilation technology during thoracic surgery that can cause serious clinical problems. We aimed to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt during OLV in adults undergoing thoracic surgery with dexmedetomidine (Dex) versus placebo to assess the influence and safety of using Dex.
Randomized controlled trials comparing lung protection in patients who underwent thoracic surgery with Dex or a placebo were retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI database. The following information was extracted from the paper: arterial oxygen partial pressure (PaO2), PaO2/inspired oxygen concentration (PaO2/FiO2, oxygenation index [OI]), intrapulmonary shunt (calculated as Qs/Qt), mean arterial pressure (MAP), heart rate (HR), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, superoxide dismutase (SOD), and malondialdehyde (MDA).
Fourteen randomized controlled trials were included containing a total of 625 patients. Compared with placebo group, Dex significantly increased PaO2/FiO2(standard mean difference [SMD] = 0.98, 95% confidence interval [CI] [0.72, 1.23], P < 0.00001). Besides, Qs/Qt (SMD= -1.22, 95% CI [-2.20, -0.23], P = 0.020), HR (SMD= -0.69, 95% CI [-1.20, 0.17], P = 0.009), MAP (SMD= -0.44, 95% CI [-0.84, 0.04], P = 0.030), the concentrations of TNF-α (SMD = -1.55, 95% CI [-2.16, -0.95], P <0.001), and IL-6 (SMD = -1.53, 95% CI [-2.37, -0.70], P = 0.0003) were decreased in the treated group, when compared to placebo group. No significant difference was found in MDA (SMD = -1.14, 95% CI [-3.48, 1.20], P = 0.340) and SOD (SMD = 0.41, 95% CI [-0.29, 1.10], P = 0.250) between the Dex group and the placebo group. Funnel plots did not detect any significant publication bias.
Dex may improve OI and reduce intrapulmonary shunt during OLV in adults undergoing thoracic surgery. However, this conclusion might be weakened by the limited number of pooled studies and patients.
单肺通气（OLV）是胸外科手术中常用的通气技术，但可能引发严重的临床问题。我们旨在进行一项荟萃分析，比较在胸外科手术成年患者中使用右美托咪定（Dex）与安慰剂进行OLV时的氧合和肺内分流情况，以评估使用Dex的影响和安全性。
从PubMed、EMBASE、MEDLINE、Cochrane图书馆和中国知网数据库中检索比较使用Dex或安慰剂进行胸外科手术患者肺保护情况的随机对照试验。从论文中提取以下信息：动脉血氧分压（PaO2）、PaO2/吸入氧浓度（PaO2/FiO2，氧合指数[OI]）、肺内分流（计算为Qs/Qt）、平均动脉压（MAP）、心率（HR）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、超氧化物歧化酶（SOD）和丙二醛（MDA）。
纳入14项随机对照试验，共625例患者。与安慰剂组相比，Dex显著提高了PaO2/FiO2（标准化均数差[SMD]=0.98，95%置信区间[CI][0.72，1.23]，P<0.00001）。此外，与安慰剂组相比，治疗组的Qs/Qt（SMD=-1.22，95%CI[-2.20，-0.23]，P=0.020）、HR（SMD=-0.69，95%CI[-1.20，0.17]，P=0.009）、MAP（SMD=-0.44，95%CI[-0.84，0.04]，P=0.030）、TNF-α浓度（SMD=-1.55，95%CI[-2.16，-0.95]，P<0.001）和IL-6浓度（SMD=-1.53，95%CI[-2.37，-0.70]，P=0.0003）均降低。Dex组与安慰剂组在MDA（SMD=-1.14，95%CI[-3.48，1.20]，P=0.340）和SOD（SMD=0.41，95%CI[-0.29，1.10]，P=0.250）方面未发现显著差异。漏斗图未检测到任何显著的发表偏倚。
Dex可能改善胸外科手术成年患者OLV期间的OI并减少肺内分流。然而，这一结论可能因汇总研究和患者数量有限而受到削弱。
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