围手术期右美托咪定对全身麻醉患者术后胃肠功能恢复的影响：一项系统评价和荟萃分析
Effect of perioperative dexmedetomidine on recovery of postoperative gastrointestinal function in patients with general anesthesia: a systematic review and meta-analysis.
作者信息
Liu Yanping, Liang Hongbin, Sun Yuanyuan, Liu Weihua, Ye Li, He Wanyou, Wang Hanbing
机构信息
Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan City, 25000, China.
Department of Anesthesiology, The First People's Hospital of Foshan, Lingnan Road 81#, Foshan City, 528000, China.
出版信息
BMC Anesthesiol. 2024 Dec 28;24(1):479. doi: 10.1186/s12871-024-02868-0.
BACKGROUND
There is controversy surrounding the influence of dexmedetomidine on the recovery of postoperative gastrointestinal dysfunction in patients under general anesthesia. The main purpose of this meta-analysis is to evaluate the effect of dexmedetomidine administration during the perioperative period on the recovery of gastrointestinal function in patients under general anesthesia.
METHODS
A systematic review and meta-analysis with trial sequential analysis was performed to identify randomized controlled trials comparing dexmedetomidine administration with placebo for the recovery of gastrointestinal function. The primary outcomes were gastrointestinal function; first oral feeding time; incidences of postoperative nausea and vomiting, postoperative nausea, and postoperative vomiting; time to first bowel sound; time to first flatus; and time to first defecation. The secondary outcome was the length of hospital stay.
RESULTS
A total of 20 studies comparing 2,470 participants were included in this meta-analysis. Perioperative dexmedetomidine administration did not result in a significant reduction in the time to first oral feeding (MD= -7.91, 95% CI = - 16.45 to 0.62, P = 0.07). However, dexmedetomidine administration was associated with a decreased incidence of postoperative nausea and vomiting (RR = 0.72, 95% CI = 0.58 to 0.88, P = 0.001), time to first flatus (MD= -6.73, 95% CI= -10.31 to -3.15, P = 0.0002), and time to first defecation (MD= -12.01, 95% CI = -22.40 to -1.61, P = 0.02).
CONCLUSIONS
Perioperative dexmedetomidine administration can promote the recovery of gastrointestinal function and reduce the length of hospital stay after abdominal surgery. The optimal dose and timing of dexmedetomidine and the influence on non-abdominal surgery need further investigation.
TRIAL REGISTRATION
The study protocol was registered in the PROSPERO database (registration number: CRD42023443708) on July 9, 2023.
背景
右美托咪定对全身麻醉患者术后胃肠功能障碍恢复的影响存在争议。本荟萃分析的主要目的是评估围手术期使用右美托咪定对全身麻醉患者胃肠功能恢复的影响。
方法
进行了一项系统评价和荟萃分析，并采用试验序贯分析来确定比较右美托咪定与安慰剂对胃肠功能恢复影响的随机对照试验。主要结局指标为胃肠功能；首次经口进食时间；术后恶心呕吐、术后恶心和术后呕吐的发生率；首次肠鸣音时间；首次排气时间；首次排便时间。次要结局指标为住院时间。
结果
本荟萃分析共纳入20项研究，涉及2470名参与者。围手术期使用右美托咪定并未显著缩短首次经口进食时间（MD = -7.91，95%CI = -16.45至0.62，P = 0.07）。然而，使用右美托咪定与术后恶心呕吐发生率降低（RR = 0.72，95%CI = 0.58至0.88，P = 0.001）、首次排气时间缩短（MD = -6.73，95%CI = -10.31至-3.15，P = 0.0002）以及首次排便时间缩短（MD = -12.01，95%CI = -22.40至-1.61，P = 0.02）相关。
结论
围手术期使用右美托咪定可促进腹部手术后胃肠功能的恢复并缩短住院时间。右美托咪定的最佳剂量和给药时机以及对非腹部手术的影响需要进一步研究。
试验注册
该研究方案于2023年7月9日在PROSPERO数据库中注册（注册号：CRD42023443708）。
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