Team Health Research Institute, Tampa General Hospital, Tampa, FL.
University of Texas Medical Branch, Galveston, TX.
J Cardiothorac Vasc Anesth. 2021 Apr;35(4):1134-1142. doi: 10.1053/j.jvca.2020.10.022. Epub 2020 Oct 17.
To evaluate reports from the published literature of all randomized clinical trials (RCT) comparing postoperative sedation with dexmedetomidine versus propofol in adult patients, after open cardiac surgery.
A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was completed through June 2020. Meta-analysis of all published RCT comparing dexmedetomidine versus propofol utilization in the postoperative phase, using the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.
Assemblage and critical discussion of 11 RCTs comparing postoperative sedation from standard published reports from 2003 to 2019.
The study comprised 1,184 patients and analyzed critical discussion of time-based parameters (time to extubation, intensive care unit length of stay, and hospital length of stay) and nontime-dependent factors (delirium, bradycardia, and hypotension).
Time to extubation was significantly reduced in the dexmedetomidine group (standardized mean difference [SMD] = -0.70, 95% confidence interval [CI] -0.98 to -0.42, p < 0.001); however, no difference in mechanical ventilation time was observed (SMD = -0.72, 95% CI -1.60 to 0.15, N.S.). Dexmedetomidine significantly reduced the intensive care unit length of stay (SMD = 0.23, 95% CI -1.06 to -0.16, p = 0.008), but this did not translate into a reduced hospital length of stay (SMD = -1.13, 95% CI -2.43 to 0.16, N.S). For nontime-dependent factors, incidence of delirium was unaffected between groups (odds ratio [OR]: 0.68, 95% CI 0.43-1.06, N.S), and higher rates of bradycardia (OR: 3.39, 95% CI: 1.20-9.55, p = 0.020) and hypotension (OR: 1.68, 95% CI 1.09-2.58, p = 0.017) were reported with propofol.
Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former did not seem to contribute to an overall reduction in hospital length of stay or improvement in postoperative outcomes of heart valve surgery and CABG patients.
评估 2003 年至 2019 年已发表文献中所有比较心脏直视手术后使用右美托咪定与丙泊酚进行术后镇静的随机临床试验（RCT）的报告。
通过 Medline、EMBASE、Web of Science 和美国医疗保健研究与质量局数据库进行计算机检索，检索截至 2020 年 6 月。使用标准的系统评价和荟萃分析首选报告项目清单，对所有比较右美托咪定与丙泊酚在术后阶段使用的已发表 RCT 进行荟萃分析。
综合并批判性讨论 2003 年至 2019 年发表的 11 项 RCT 中关于术后镇静的标准报告。
该研究共纳入 1184 例患者，分析了基于时间的参数（拔管时间、重症监护病房住院时间和住院时间）和非时间依赖因素（谵妄、心动过缓、低血压）的临界讨论。
与丙泊酚组相比，右美托咪定组的拔管时间明显缩短（标准化均数差[SMD]=-0.70，95%置信区间[CI]-0.98 至-0.42，p<0.001）；但机械通气时间无差异（SMD=-0.72，95%CI-1.60 至 0.15，N.S.）。右美托咪定可显著缩短重症监护病房住院时间（SMD=0.23，95%CI-1.06 至-0.16，p=0.008），但这并未转化为住院时间的缩短（SMD=-1.13，95%CI-2.43 至 0.16，N.S.）。对于非时间依赖因素，两组间谵妄发生率无差异（比值比[OR]：0.68，95%CI 0.43-1.06，N.S.），丙泊酚组报告的心动过缓和低血压发生率更高（OR：3.39，95%CI：1.20-9.55，p=0.020）和（OR：1.68，95%CI 1.09-2.58，p=0.017）。
尽管与丙泊酚相比，右美托咪定在 ICU 时间上具有优势，但前者似乎并没有导致心脏瓣膜手术和 CABG 患者的住院时间总体缩短或术后结果改善。
