针对非心脏手术患儿围手术期呼吸不良事件的预防性药物干预：一项系统评价和荟萃分析。
Prophylactic pharmacological interventions against perioperative respiratory adverse events in children undergoing noncardiac surgery: a systematic review and meta-analysis.
作者信息
Deng Qi-Wen, Tan Wen-Cheng, Zhan Ya-Qing, Wang Xi-Wen, Lai Han-Jin, Wen Shi-Hong
机构信息
Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan 2Nd Road, Guangzhou, 510080, China.
Department of Endoscopy, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China.
出版信息
J Anesth. 2025 Apr;39(2):248-264. doi: 10.1007/s00540-024-03453-y. Epub 2025 Jan 11.
PURPOSE
Perioperative respiratory adverse event (PRAE) is one of the most common complications in pediatric anesthesia. We aimed to evaluate the efficacy of perioperative pharmacological interventions to prevent the development of PRAE in children undergoing noncardiac surgery.
METHODS
PubMed, Embase, Cochrane Library and ClinicalTrials.gov were searched for randomized controlled trials (RCT) of prophylactic pharmacological interventions for PRAE among surgical children from inception to 5 August 2024. Pairwise meta-analyses were conducted to compare the effects of an intervention with placebo or another intervention on overall PRAE and their subtypes, including laryngospasm, bronchospasm, oxygen desaturation, airway obstruction, coughing and stridor. Risk of bias was assessed using the Cochrane Collaboration tool.
RESULTS
Seven categories of prophylactic interventions were identified. Twenty-nine RCTs with 4452 children were included. Compared with placebo, lidocaine reduced the odds ratio (OR) of overall PRAE ( 0.27 [95% CI] [0.17, 0.42]) and laryngospasm (0.38 [0.22, 0.67]); dexmedetomidine reduced the OR of PRAE (0.31 [0.12, 0.76]), laryngospasm (0.31 [0.10, 0.91]), coughing (0.24 [0.14, 0.41]) and oxygen desaturation (0.54 [0.35, 0.84]); β-adrenoreceptor agonists reduced the OR of PRAE (0.45 [0.24, 0.83]), coughing (0.36 [0.13, 0.95]) and oxygen desaturation (0.66 [0.45, 0.98]). Compared with sevoflurane induction, intravenous propofol induction lowered the OR of PRAE (0.35 [0.16, 0.74]), laryngospasm (0.17 [0.06, 0.48]) and airway obstruction (0.32 [0.17, 0.63]).
CONCLUSIONS
The meta-analysis demonstrated prophylactic potential of lidocaine, dexmedetomidine, β-adrenoreceptor agonists and propofol induction technique against PRAE, but it should be interpreted cautiously due to inconsistent PRAE definition and correlation of subtypes within the composite outcome.
TRIAL REGISTRATION
PROSPERO (CRD42020220028). Registered 11 December 2020. Updated 3 September 2024.
目的
围手术期呼吸不良事件（PRAE）是小儿麻醉中最常见的并发症之一。我们旨在评估围手术期药物干预对预防非心脏手术患儿发生PRAE的效果。
方法
检索了PubMed、Embase、Cochrane图书馆和ClinicalTrials.gov，以查找从开始到2024年8月5日期间针对手术患儿PRAE预防性药物干预的随机对照试验（RCT）。进行了成对荟萃分析，以比较一种干预措施与安慰剂或另一种干预措施对总体PRAE及其亚型（包括喉痉挛、支气管痉挛、氧饱和度下降、气道阻塞、咳嗽和喘鸣）的影响。使用Cochrane协作工具评估偏倚风险。
结果
确定了七类预防性干预措施。纳入了29项RCT，共4452名儿童。与安慰剂相比，利多卡因降低了总体PRAE的比值比（OR）（0.27 [95% CI] [0.17, 0.42]）和喉痉挛的OR（0.38 [0.22, 0.67]）；右美托咪定降低了PRAE的OR（0.31 [0.12, 0.76]）、喉痉挛的OR（0.31 [0.10, 0.91]）、咳嗽的OR（0.24 [0.14, 0.41]）和氧饱和度下降的OR（0.54 [0.35, 0.84]）；β-肾上腺素能受体激动剂降低了PRAE的OR（0.45 [0.24, 0.83]）以及咳嗽的OR（0.36 [0.13, 0.95]）和氧饱和度下降的OR（0.66 [0.45, 0.98]）。与七氟醚诱导相比，静脉注射丙泊酚诱导降低了PRAE的OR（0.35 [0.16, 0.74]）、喉痉挛的OR（0.17 [0.06, 0.48]）和气道阻塞的OR（0.32 [0.17, 0.63]）。
结论
荟萃分析表明，利多卡因、右美托咪定、β-肾上腺素能受体激动剂和丙泊酚诱导技术对PRAE具有预防潜力，但由于PRAE定义不一致以及复合结局中各亚型之间的相关性，应谨慎解读。
试验注册
PROSPERO（CRD42020220028）。于2020年12月11日注册。于2024年9月3日更新。
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