2020 年第 7 期 第 15 卷

右美托咪定在剖宫产产妇中的麻醉效果及安全性的Meta分析

The analgesic effect and adverse reactions of dexmedetomidine in women undergoing elective cesarean section using spinal or spinal-epidural anesthesia

作者：方爱莉1李岩2路桂军3马骏2

英文作者：Fang Aili1 Li Yan2 Lu Guijun3 Ma Jun2

单位：1山西白求恩医院麻醉科山西医学科学院，太原030032；2首都医科大学附属北京安贞医院麻醉中心100029；3北京清华长庚医院疼痛科102218

英文单位：1Department of Anesthesiology Shanxi Academy of Medical Sciences Shanxi Bethune Hospital Taiyuan 030032 China； 2Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China； 3Department of Pain Beijing Tsinghua Changgeng Hospital Beijing 102218 China

关键词：剖宫产；右美托咪定；蛛网膜下腔阻滞；硬膜外麻醉

英文关键词：Cesareansection；Dexmedetomidine；Subarachnoidblock；Epiduralanesthesia

• 摘要：

• 目的评价右美托咪定在剖宫产产妇中的麻醉效果及安全性。方法计算机检索Cochrane Library，EMBASE，PubMed数据库（建库至2019年2月），由2名作者根据纳入和排除标准独立筛选右美托咪定在剖宫产产妇中应用的相关文献并提取资料。对照组措施为蛛网膜下腔阻滞（腰麻）或者腰麻-硬膜外联合麻醉（腰硬联合麻醉）应用布比卡因，或布比卡因联合芬太尼。观察组在对照组基础上加用右美托咪定。分析右美托咪定在剖宫产产妇中应用的麻醉效果及安全性。结果共纳入6项研究402例剖宫产产妇，结果显示观察组感觉阻滞平面达峰时间短于对照组（均数差=-0.54，95%置信区间：-1.05～-0.03，P=0.04），感觉阻滞持续时间长于对照组（均数差=64.15，95%置信区间：49.11～79.20，P＜0.01），镇静率高于对照组，术后首次疼痛发作时间与对照组比较显著延后，术后疼痛、恶心呕吐、术后寒战及发热发生率低于对照组（均P＜0.05）。结论剖宫产产妇腰麻或腰硬联合麻醉基础上加用右美托咪定临床获益更多，且安全性较好。

• ObjectiveTo evaluate the anesthetic efficacy and safety of dexmedetomidine in cesarean section. Methods The search terms "dexmedetomidine" and "cesarean section" were searched by the computer in the Cochrane Library, EMBASE, and PubMed databases, from the time of library construction to February 2019. In the control group, bupivacaine or bupivacaine combined with fentanyl were used for subarachnoid block (lumbar anesthesia) or combined spinal epidural anesthesia (lumbar epidural anesthesia). In the observation group, dexmedetomidine was added on the basis of the control group. The efficacy and safety of dexmedetomidine on the basis of spinal anesthesia or combined spinal epidural anesthesia were analyzed. Results  A total of 402 parturients were included in 6 studies. The Results   showed that the peak time of sensory block plane in observation group was shorter than that in control group ［mean difference(MD)=-0.54，95% confidence interval(CI)：-1.05 to -0.03， P=0.04］； the duration of sensory block was longer than that in control group (MD=64.15, 95%CI:49.11-79.20, P＜0.01)； the sedation rate was higher than that in control group； the incidences of postoperative pain, nausea and vomiting, postoperative shivering and fever were lower than those in control group (all P＜0.05). Conclusion The clinical efficacy of dexmedetomidine on the basis of combined spinal anesthesia or spinal epidural anesthesia in cesarean delivery women is good.