Department of Cardiovascular Medicine, 159393Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Perfusion. 2023 Apr;38(3):539-546. doi: 10.1177/02676591211066232. Epub 2022 Mar 1.
The benefits of prophylactic dexmedetomidine use in patients undergoing cardiac surgery remain controversial. The aim of this meta-analysis was to investigate the short-term clinical outcomes of dexmedetomidine use versus non-dexmedetomidine use.
Systematic searches using PubMed, Embase, and the Cochrane Library were carried out for English articles published from inception to 23 September 2021. This was followed by a meta-analysis investigating delirium, the length of delirium, mortality, bradycardia, hypotension, the length of intensive care unit (ICU) and hospital stay, and the duration of mechanical ventilation.
Ten randomized controlled trials (RCTs) totaling 2550 patients were included. In the dexmedetomidine group incidence of delirium was 13.5%, compared with 16.1% in the control group. The risk ratio (RR) for the comparison was 0.69 (95% CI, 0.47 - 1.00; = .052). In addition, there were no differences in mortality (RR, 0.56; 95% CI, 0.27 - 1.14; = .109), the incidence of bradycardia (RR, 1.20; 95% CI, 0.91 - 1.57; = .201), the incidence of hypotension (RR, 0.90; 95% CI, 0.57 - 1.44; = .674), and the length of delirium mean difference (MD, -0.99; 95% CI, -2.20 to 0.21; = .106). However, prophylactic dexmedetomidine use significantly reduced the duration of mechanical ventilation (MD, -2.03; 95% CI, -3.35 to -0.70; = .003), length of ICU stay (MD, -3.17; 95% CI, -5.10 to -1.24; = .001), and length of hospital stay (MD, -1.76; 95% CI, -2.88 to -0.66; = .002).
Prophylactic dexmedetomidine use did not decrease the incidence of delirium in patients undergoing cardiac surgery, but significantly reduced the duration of mechanical ventilation, length of ICU stay, and length of hospital stay.
在接受心脏手术的患者中预防性使用右美托咪定的益处仍存在争议。本荟萃分析的目的是研究右美托咪定与非右美托咪定使用的短期临床结局。
系统检索了从创建到 2021 年 9 月 23 日发表的英文文章，使用了 PubMed、Embase 和 Cochrane Library。随后进行了荟萃分析，调查了谵妄、谵妄持续时间、死亡率、心动过缓、低血压、重症监护病房（ICU）和住院时间以及机械通气时间。
纳入了 10 项随机对照试验（RCT），共 2550 例患者。在右美托咪定组，谵妄的发生率为 13.5%，而对照组为 16.1%。比较的风险比（RR）为 0.69（95%CI，0.47-1.00； =.052）。此外，死亡率（RR，0.56；95%CI，0.27-1.14； =.109）、心动过缓发生率（RR，1.20；95%CI，0.91-1.57； =.201）、低血压发生率（RR，0.90；95%CI，0.57-1.44； =.674）和谵妄持续时间的均数差（MD，-0.99；95%CI，-2.20 至 0.21； =.106）均无差异。然而，预防性使用右美托咪定可显著缩短机械通气时间（MD，-2.03；95%CI，-3.35 至-0.70； =.003）、ICU 入住时间（MD，-3.17；95%CI，-5.10 至-1.24； =.001）和住院时间（MD，-1.76；95%CI，-2.88 至-0.66； =.002）。
在接受心脏手术的患者中预防性使用右美托咪定并未降低谵妄发生率，但显著缩短了机械通气时间、ICU 入住时间和住院时间。
