Xiao Zizhen, He Tao, Jiang Xinping, Xie Fengyong, Xia Lihua, Zhou Huiming
Department of Anesthesiology, The Central Hospital of Loudi, Loudi, China.
Department of Pediatrics, The Central Hospital of Loudi, Loudi, China.
Transl Pediatr. 2022 Feb;11(2):260-269. doi: 10.21037/tp-22-20.
During treatment of acute respiratory failure (ARF) in children, sedation can reduce pain, improve tolerance, and reduce the incidence of adverse events, so selecting an appropriate sedation strategy is very important for improving prognosis and quality of life. Both dexmedetomidine and propofol have good sedative effects, so we investigated the application of these drugs in critically ill children with ARF by literature search and meta-analysis.
We searched Embase, The Cochrane Library, PubMed, Ovid, Clinicaltrials.org, and Google Scholar for randomized controlled trials (RCTs) preferentially but not exclusively, and used RevMan 5.4 to analyze the screened literature.
Seven studies were included in the quantitative meta-analysis, with a total of 1,188 patients. There was no significant difference in the effect of dexmedetomidine and propofol on the duration of tracheal intubation in children with ARF [mean difference (MD) =-0.05; 95% confidence interval (CI): (-0.42, 0.32); Z=0.26; P=0.79], but dexmedetomidine sedation could reduce the intensive care unit (ICU) stay in children with ARF [MD =-0.62; 95% CI: (-1.08, -0.16); Z=2.65; P=0.008], and shorten the total hospital stay [MD =-1.94; 95% CI: (-2.63, -1.25); Z=5.48; P<0.00001]. There was no significant effect on mortality between the two groups [odds ratio (OR) =0.48; 95% CI: (0.19, 1.25); Z=1.50; P=0.13]. The incidence rate of bradycardia with dexmedetomidine sedation was higher than with propofol [OR =12.30; 95% CI: (2.28, 66.47); Z=2.92; P=0.004], and the incidence of hypotension was also higher [OR =6.99, 95% CI: (1.22, 39.86); Z=2.19; P=0.03].
Compared with propofol, dexmedetomidine can significantly reduce the ICU stay and hospital stay. However, bradycardia and hypotension may occur during the use of dexmedetomidine, which requires close attention and timely intervention.
在儿童急性呼吸衰竭（ARF）的治疗过程中，镇静可减轻疼痛、提高耐受性并降低不良事件的发生率，因此选择合适的镇静策略对于改善预后和生活质量非常重要。右美托咪定和丙泊酚均具有良好的镇静效果，因此我们通过文献检索和荟萃分析研究了这些药物在患有ARF的危重症儿童中的应用。
我们优先但不限于在Embase、Cochrane图书馆、PubMed、Ovid、Clinicaltrials.org和谷歌学术搜索随机对照试验（RCT），并使用RevMan 5.4分析筛选出的文献。
七项研究纳入定量荟萃分析，共1188例患者。右美托咪定和丙泊酚对ARF患儿气管插管持续时间的影响无显著差异[平均差（MD）=-0.05；95%置信区间（CI）：（-0.42，0.32）；Z=0.26；P=0.79]，但右美托咪定镇静可缩短ARF患儿在重症监护病房（ICU）的住院时间[MD=-0.62；95%CI：（-1.08，-0.16）；Z=2.65；P=0.008]，并缩短总住院时间[MD=-1.94；95%CI：（-2.63，-1.25）；Z=5.48；P<0.00001]。两组之间的死亡率无显著影响[比值比（OR）=0.48；95%CI：（0.19，1.25）；Z=1.50；P=0.13]。右美托咪定镇静时心动过缓的发生率高于丙泊酚[OR=12.30；95%CI：（2.28，66.47）；Z=2.92；P=0.004]，低血压的发生率也更高[OR=6.99，95%CI：（1.22，39.86）；Z=2.19；P=0.03]。
与丙泊酚相比，右美托咪定可显著缩短ICU住院时间和总住院时间。然而，使用右美托咪定期间可能会发生心动过缓和低血压，需要密切关注并及时干预。
