CAJ | 학술논문

目的：评价围手术期老年患者应用右美托咪定镇静的有效性和安全性。方法以“右美托咪定”、“α1受体激动剂”、“老年”、“高龄”、“不良反应”、“药物不良反应”、“不良事件”、“安全性”及相应英文词汇为检索词检索中国期刊全文数据库、中国生物医学文献数据库、维普中文科技期刊数据库、万方数据库、PubMed、EMbase、Web of Science和Cochrane Library，检索时间均为建库至1013年10月，收集围手术期老年患者应用右美托咪定镇静的随机对照临试验（ RCT），采用RevMan 5.1软件对符合纳入标准的研究进行Meta分析，比较围手术期右美托咪定组和生理盐水组老年患者术中、术后心率、平均动脉压（ MAP）、芬太尼累积用量和不良反应（呕吐、低血压、心动过缓）发生率的差异，结果以加权均数差（ WMD）、相对危险度（ RR）和95%置信区间（ CI）表示。结果共纳入6项RCT研究，涉及403例老年患者，其中右美托咪定组100例，生理盐水组103例。根据改良Jadad评分，4篇为高质量文献，1篇为低质量文献。Meta分析结果显示右美托咪定组患者心率和MAP明显低于生理盐水组（心率：WMD=-11.70，95%CI为-13.76~-9.65，P﹤0.01；MAP：WMD=-8.74，95%CI为-10.81~-6.68，P﹤0.01），芬太尼累积用量明显少于生理盐水组（ RR=-7.11，95%CI为-11.30~-3.14，P ﹤0.01）。右美托咪定组和生理盐水组患者围手术期呕吐发生率（ RR =-0.11，95%CI为-0.16~-0.03，P=0.13）、心动过缓发生率（ RR=5.16，95%CI为0.63~41.14， P=0.13）和低血压发生率（RR=1.01，95%CI为0.18~3.69，P=0.98），差异均无统计学意义。结论右美托咪定在老年患者围手术期应用可稳定心率和平均动脉压，镇静效果明确，安全性较好。
목적：평개위수술기노년환자응용우미탁미정진정적유효성화안전성。방법이“우미탁미정”、“α1수체격동제”、“노년”、“고령”、“불량반응”、“약물불량반응”、“불량사건”、“안전성”급상응영문사회위검색사검색중국기간전문수거고、중국생물의학문헌수거고、유보중문과기기간수거고、만방수거고、PubMed、EMbase、Web of Science화Cochrane Library，검색시간균위건고지1013년10월，수집위수술기노년환자응용우미탁미정진정적수궤대조림시험（ RCT），채용RevMan 5.1연건대부합납입표준적연구진행Meta분석，비교위수술기우미탁미정조화생리염수조노년환자술중、술후심솔、평균동맥압（ MAP）、분태니루적용량화불량반응（구토、저혈압、심동과완）발생솔적차이，결과이가권균수차（ WMD）、상대위험도（ RR）화95%치신구간（ CI）표시。결과공납입6항RCT연구，섭급403례노년환자，기중우미탁미정조100례，생리염수조103례。근거개량Jadad평분，4편위고질량문헌，1편위저질량문헌。Meta분석결과현시우미탁미정조환자심솔화MAP명현저우생리염수조（심솔：WMD=-11.70，95%CI위-13.76~-9.65，P﹤0.01；MAP：WMD=-8.74，95%CI위-10.81~-6.68，P﹤0.01），분태니루적용량명현소우생리염수조（ RR=-7.11，95%CI위-11.30~-3.14，P ﹤0.01）。우미탁미정조화생리염수조환자위수술기구토발생솔（ RR =-0.11，95%CI위-0.16~-0.03，P=0.13）、심동과완발생솔（ RR=5.16，95%CI위0.63~41.14， P=0.13）화저혈압발생솔（RR=1.01，95%CI위0.18~3.69，P=0.98），차이균무통계학의의。결론우미탁미정재노년환자위수술기응용가은정심솔화평균동맥압，진정효과명학，안전성교호。
Objective To evaluate the efficacy and safety of dexmedetomidine in treatment of elderly patients in perioperative period. Methods CNKI,CBM,VIP,WanFang Database,PubMed, Embase,Web of Science,and Cochrane Library from the inception to October 1013 were searched using"dexmedetomidine","α1 receptor agonist","elderly patients","aged","adverse reactions","adverse drug reactions","adverse events",and "safety" as key words. Randomized controlled trials( RCT)on dexmedetomidine treatment for elderly patients in perioperative period were collected and studies in accordance with inclusion criteria were analyzed with RevMan 5. 1 software. The differences of heart rates during and after the operation,mean arterial pressure( MAP ),the cumulative amount of fentanyl,and incidence of adverse reactions( vomiting,hypotension,bradycardia)between the dexmedetomidine group and the saline group were compared and the results were showed with weight mean difference( WMD ), ( relative risk,RR),and 95% confidence interval( CI). Results A total of 6 RCT papers involving 403 elderly patients( 100 patients in the dexmedetomidine group and 103 patients in the saline group ) were entered into this study. Of them,4 RCT papers were high quality articles and 1 were low quality articles according to the Jadad scores. The heart rates and MAP in patients in the dexmedetomidine group were markedly lower than those in the saline group[ heart rate:WMD = -11. 70,95% CI( - 13. 76 to-9. 65),P﹤0. 01;MAP:WMD= -8. 74,95% CI( -10. 81 to -6. 68),P﹤0. 01],the cumulative amount of fentanyl in patients in the dexmedetomidine group was markedly lower than that in the saline group [RR= -7. 11,95%CI:-11. 30 to -3. 14,P﹤0. 01]. There were no statistically significant differences in incidence of vomiting[RR= -0. 11,95% CI( -0. 16 to -0. 03)],bradycardia[RR=5. 16,95%CI:0. 63 to 41. 14],and hypotension[RR=1. 01,95% CI:0. 18 to 3. 69]in perioperative period between the two groups(all P﹥0. 05). Conclusion Dexmedetomidine could stabilize the heart rate and arterial pressure in elderly patients in perioperative period and have definite sedative effect and good drug safety.