Fan Heng, Zhao Yu, Sun Min, Ye Ji-Hui, Chen Guo-Dong, Zhu Jian-Hua
Dept. of Intensive Care Unit, Ningbo First Hospital, Ningbo, China.
Dept. of Nephrology, Ningbo Urology and Nephrology Hospital, Ningbo, China.
Iran J Public Health. 2017 Dec;46(12):1611-1622.
Using dexmedetomidine (Dex) as a sedative agent may benefit the clinical outcomes of post-surgery patients. We reviewed randomized controlled trials (RCTs) to assess whether use of a Dex could improve the outcomes in post-surgery critically ill adults.
We searched Medline, Embase, PubMed, and the Cochrane databases for RCTs comparing Dex with propofol or a placebo in post-operative patients, all included RCTs should be published in English before Jul 2016. Citations meeting inclusion criteria were full screened, and trial available data were abstracted independently and the Cochrane risk of bias tool was used for quality assessment.
Sixteen RCTs involving 2568 patients were subject to this meta-analysis. The use of a Dex sedative regimen was associated with a reduce delirium prevalence [odd ratio (OR):0.33, 95% confidence intervals (CI): 0.24-0.45, = 5%, <0.001], a shorter the length of ICU stay [mean difference (MD): -0.60, 95%CI: -0.69 to -0.50, =40%, <0.001] and the length of hospital stay [MD: -0.68, 95%CI: -1.21 to -0.16, =0%, =0.01]. However, using of Dex could not shorter the duration of mechanical ventilation [MD: -10.18. 95%CI: -31.08-10.72, =99%, =0.34], but could shorter the time to extubation in post-surgery patients [MD: -47.46, 95%CI: -84.63-10.67, =98%, =0.01].
The use of a Dex sedative regimen was associated with a reduce delirium prevalence, a shorter the length of ICU and hospital stay, and a shorter time to extubation in post-surgery critical ill patients.
使用右美托咪定（Dex）作为镇静剂可能有利于术后患者的临床结局。我们回顾了随机对照试验（RCT），以评估使用Dex是否能改善术后重症成年患者的结局。
我们在Medline、Embase、PubMed和Cochrane数据库中检索了比较Dex与丙泊酚或安慰剂在术后患者中的RCT，所有纳入的RCT均应在2016年7月之前以英文发表。对符合纳入标准的文献进行全面筛选，独立提取试验可用数据，并使用Cochrane偏倚风险工具进行质量评估。
16项涉及2568例患者的RCT纳入了本荟萃分析。使用Dex镇静方案与谵妄患病率降低相关[比值比（OR）：0.33，95%置信区间（CI）：0.24 - 0.45，I² = 5%，P < 0.001]，ICU住院时间缩短[平均差（MD）：-0.60，95%CI：-0.69至-0.50，I² = 40%，P < 0.001]，住院时间缩短[MD：-0.68，95%CI：-1.21至-0.16，I² = 0%，P = 0.01]。然而，使用Dex并不能缩短机械通气时间[MD：-10.18，95%CI：-31.08至10.72，I² = 99%，P = 0.34]，但可缩短术后患者拔管时间[MD：-47.46，95%CI：-84.63至10.67，I² = 98%，P = 0.01]。
使用Dex镇静方案与谵妄患病率降低、ICU和住院时间缩短以及术后重症患者拔管时间缩短相关。
