Nishizawa Toshihiro, Suzuki Hidekazu, Hosoe Naoki, Ogata Haruhiko, Kanai Takanori, Yahagi Naohisa
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
United European Gastroenterol J. 2017 Nov;5(7):1037-1045. doi: 10.1177/2050640616688140. Epub 2017 Jan 12.
Several randomized controlled trials have compared sedation with dexmedetomidine and propofol in gastrointestinal endoscopy, with contradictory results. We conducted a meta-analysis of data from randomized controlled trials that compared dexmedetomidine with propofol.
We searched PubMed, the Cochrane library, and the Igaku-chuo-zasshi database for randomized trials eligible for inclusion in our meta-analysis. We identified six eligible randomized trials from the database search, and compared the effect of propofol versus dexmedetomidine with respect to: (a) patient's satisfaction level, (b) body movement or gagging, (c) cardiopulmonary complications, and (d) change in heart rate. Data from eligible studies were combined to calculate pooled risk difference (RD) or weighted mean difference (WMD).
Compared to propofol, dexmedetomidine significantly decreased the patient's satisfaction level (WMD: -0.678, 95% confidence interval (CI): -1.149 to -0.207, = 0.0048), and there was no significant heterogeneity among the trial results. The pooled RD for developing body movement or gagging when using dexmedetomidine was 0.107 (95% CI: -0.09 to 0.305, = 0.288), with no significant differences. Compared with propofol, the pooled RD for hypotension, hypoxia, and bradycardia with dexmedetomidine sedation were -0.029 (95% CI: -0.11 to 0.05), -0.080 (95% CI: -0.178 to 0.018), and 0.022 (95% CI: -0.027 to 0.07), respectively, with no significant differences. Compared to propofol, dexmedetomidine significantly decreased the heart rate (WMD: -10.41, 95% CI: -13.77 to -7.051, ≤ 0.0001), without significant heterogeneity.
In gastrointestinal endoscopy, patient satisfaction level was higher in propofol administration, when compared to dexmedetomidine. The risk of complications was similar.
多项随机对照试验比较了右美托咪定与丙泊酚在胃肠内镜检查中的镇静效果，但结果相互矛盾。我们对比较右美托咪定与丙泊酚的随机对照试验数据进行了荟萃分析。
我们检索了PubMed、Cochrane图书馆和《医学中央杂志》数据库，以查找符合纳入我们荟萃分析条件的随机试验。我们从数据库检索中确定了6项符合条件的随机试验，并比较了丙泊酚与右美托咪定在以下方面的效果：（a）患者满意度水平；（b）身体移动或呛咳；（c）心肺并发症；（d）心率变化。将符合条件的研究数据合并，以计算合并风险差异（RD）或加权平均差异（WMD）。
与丙泊酚相比，右美托咪定显著降低了患者满意度水平（WMD：-0.678，95%置信区间（CI）：-1.149至-0.207，P = 0.0048），试验结果之间无显著异质性。使用右美托咪定时出现身体移动或呛咳的合并RD为0.107（95%CI：-0.09至0.305，P = 0.288），无显著差异。与丙泊酚相比，右美托咪定镇静时低血压、低氧血症和心动过缓的合并RD分别为-0.029（95%CI：-0.11至0.05）、-0.080（95%CI：-0.178至0.018）和0.022（95%CI：-0.027至0.07），无显著差异。与丙泊酚相比，右美托咪定显著降低了心率（WMD：-10.41，95%CI：-13.77至-7.051，P≤0.0001），无显著异质性。
在胃肠内镜检查中，与右美托咪定相比，丙泊酚给药时患者满意度水平更高。并发症风险相似。
