Outpatient Nursing Department, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China.
Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China.
PLoS One. 2018 Mar 1;13(3):e0193303. doi: 10.1371/journal.pone.0193303. eCollection 2018.
Cardiac surgery patients often experience several types of tachyarrhythmias after admission to the intensive care unit (ICU), which increases mortality and morbidity. Dexmedetomidine (DEX) is a popular medicine used for sedation in the ICU, and its other pharmacological characteristics are gradually being uncovered.
To determine whether DEX has an antiarrhythmic effect after cardiac surgery.
The three primary databases MEDLINE, Embase (OVID SP) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched, and all English-language and randomized control-designed clinical publications comparing DEX to control medicines for sedation after elective cardiac surgery were included. Two colleagues independently extracted the data and performed other quality assessments. A subgroup analysis was performed according to the different medicines used and whether cardiopulmonary bypass (CPB) was applied. All tachyarrhythmias that occurred in the atria and ventricles were analyzed.
A total of 1295 patients in 9 studies met the selection criteria among 2587 studies that were screened. After quantitative synthesis, our results revealed that the DEX group was associated with a lower incidence of ventricular arrhythmia (VA, OR 0.24, 95% CI 0.09-0.64, I2 = 0%, P = 0.005) than the control group. Subgroup analysis did not reveal a significant difference between the DEX and propofol subgroups (OR 0.13, 95% CI 0.03-0.56, I2 = 0%, P = 0.007). Additionally, no difference in the incidence of atrial fibrillation (AF) was observed regardless of the different control medicines (OR 0.82, 95% CI 0.60-1.10, I2 = 25%, P = 0.19) or whether CPB was applied.
This meta-analysis revealed that DEX has an antiarrhythmic effect that decreases the incidence of VA compared to other drugs used for sedation following cardiac surgery. DEX may not have an effect on AF, but cautious interpretation should be exercised due to high heterogeneity.
心脏手术患者在入住重症监护病房（ICU）后经常会出现多种类型的心动过速，这会增加死亡率和发病率。右美托咪定（DEX）是 ICU 镇静中常用的一种药物，其其他药理学特性也逐渐被揭示。
确定 DEX 在心脏手术后是否具有抗心律失常作用。
检索了 MEDLINE、Embase（OVID SP）和 Cochrane 中央对照试验注册库（CENTRAL）三个主要数据库，并纳入了所有比较 DEX 与选择性心脏手术后镇静用对照药物的英文随机对照设计临床出版物。两位同事独立提取数据并进行了其他质量评估。根据使用的不同药物和是否应用体外循环（CPB）进行了亚组分析。分析了心房和心室中发生的所有心动过速。
在筛选出的 2587 项研究中，共有 9 项研究的 1295 名患者符合入选标准。经过定量综合分析，我们的结果表明，DEX 组的室性心律失常（VA）发生率低于对照组（OR 0.24，95%CI 0.09-0.64，I2=0%，P=0.005）。亚组分析显示，DEX 与丙泊酚亚组之间无显著差异（OR 0.13，95%CI 0.03-0.56，I2=0%，P=0.007）。此外，无论使用的对照药物不同（OR 0.82，95%CI 0.60-1.10，I2=25%，P=0.19）或是否应用 CPB，房颤（AF）的发生率均无差异。
这项荟萃分析表明，与心脏手术后镇静用其他药物相比，DEX 具有抗心律失常作用，可降低 VA 的发生率。DEX 可能对 AF 没有影响，但由于存在高度异质性，应谨慎解释。
