Wang Wenzhu, Liu Jian, Ye Haibo, Wang Mingshan, Wang Tao
Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong, P.R. China.
Department of Emergency, Jining No. 1 People's Hospital, Jining, Shandong, P.R. China.
J Cardiovasc Pharmacol. 2022 Mar 1;79(3):315-324. doi: 10.1097/FJC.0000000000001196.
Tachyarrhythmias after cardiac surgery is a common occurrence in clinical practice, which can be life threatening. We searched 6 databases, including Embase, PubMed, Cochrane, CNKI, Wanfang, and Sinomed, to evaluate the effect of dexmedetomidine on tachyarrhythmias after adult cardiac surgery. The primary end point was the number of patients with atrial fibrillation (AF) after cardiac surgery. The secondary end points included the number of patients with supraventricular tachycardia or with ventricular tachycardia or with ventricular fibrillation or with myocardial infarction or deceased patients, the duration of mechanical ventilation, the intensive care unit stay, hospital stay, and the number of patients with bradycardia and those with hypotension. Among the 1388 retrieved studies, 18 studies (n = 3171 participants) met our inclusion criteria. Dexmedetomidine reduced the incidence of AF by 17% [relative risk (RR) = 0.83; 95% confidence interval (CI), 0.73-0.93; P = 0.002]. Through subgroup analysis, we found that when the maintenance dose of dexmedetomidine was >0.7 µg·kg-1·h-1, the effect of preventing AF was obvious (RR = 0.58; 95%CI 0.43-0.78; P = 0.0003). Dexmedetomidine also reduced the incidence of supraventricular tachycardia by approximately 70% (RR = 0.29; 95% CI, 0.11-0.77; P = 0.01) and the incidence of ventricular tachycardia by approximately 80% (RR = 0.23; 95% CI, 0.08-0.63; P = 0.004) but had no effect on ventricular fibrillation (RR = 1.02; 95% CI, 0.14-7.31; P = 0.99). The major side effect of dexmedetomidine was bradycardia. Dexmedetomidine can reduce the incidence of AF (especially high dosages), supraventricular tachycardia, and ventricular tachycardia after cardiac surgery in adults, but it does not affect the occurrence of ventricular fibrillation.
心脏手术后的快速性心律失常在临床实践中很常见，可能危及生命。我们检索了6个数据库，包括Embase、PubMed、Cochrane、中国知网、万方和中国生物医学文献数据库，以评估右美托咪定对成人心脏手术后快速性心律失常的影响。主要终点是心脏手术后发生心房颤动（AF）的患者数量。次要终点包括发生室上性心动过速、室性心动过速、室颤、心肌梗死的患者数量或死亡患者数量、机械通气时间、重症监护病房停留时间、住院时间，以及发生心动过缓和低血压的患者数量。在检索到的1388项研究中，18项研究（n = 3171名参与者）符合我们的纳入标准。右美托咪定使AF的发生率降低了17%[相对危险度（RR）= 0.83；95%置信区间（CI），0.73 - 0.93；P = 0.002]。通过亚组分析，我们发现当右美托咪定的维持剂量>0.7 µg·kg-1·h-1时，预防AF的效果明显（RR = 0.58；95%CI 0.43 - 0.78；P = 0.0003）。右美托咪定还使室上性心动过速的发生率降低了约70%（RR = 0.29；95%CI，0.11 - 0.77；P = 0.01），室性心动过速的发生率降低了约80%（RR = 0.23；95%CI，0.08 - 0.63；P = 0.004），但对室颤没有影响（RR = 1.02；95%CI，0.14 - 7.31；P = 0.99）。右美托咪定的主要副作用是心动过缓。右美托咪定可以降低成人心脏手术后AF（尤其是高剂量时）、室上性心动过速和室性心动过速的发生率，但不影响室颤的发生。
