右美托咪啶对眼压升高的缓解作用：Meta分析及试验序贯分析的系统评价

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右美托咪啶对眼压升高的缓解作用：Meta分析及试验序贯分析的系统评价

翻译：吴学艳  编辑：冯玉蓉  审校：曹莹

研究目的：右美托咪啶是否能有效缓解眼压（IOP）升高尚无定论，本研究旨在评估右美托咪啶对需全麻气管插管的成人手术患者IOP的影响。

设计：系统评价和meta分析

干预：术中静脉注射右美托咪啶

测量：眼压

方法：检索PubMed、Embase、Scopus、Web of Science、Cochrane Library、Google Scholar、万方数据库及CNKI从建库到2020年4月14日的数据。对需要全身麻醉和气管插管的成年手术患者进行随机对照试验，比较静脉注射右美托咪定和安慰剂对IOP水平的影响，这些为Meta分析提供足够信息的试验被认为是合格的。

主要结果:纳入的29个随机对照试验中，注射琥珀酰胆碱后(MD -3.84 mm Hg；95%CI -4.80 mm Hg~-2.88 mm Hg)；气管插管后(MD -3.64 mm Hg；95%CI -4.46 mm Hg~-2.82 mm Hg)；气腹后(MD -3.12 mmHg;95% CI -3.93 mmHg~-2.30 mmHg)，以及患者头低位时(MD −4.12 mmHg;95% CI -5.39 mmHg ~ -2.85 mmHg)，给予右美托咪定后，患者IOP水平显著降低，[MD −2.04mm Hg；95%CI −2.40mm Hg~1.67mm Hg]。对这些结果的试验序贯分析具有结论性。

结论：右美托咪啶能有效抑制IOP升高，应特别考虑在高危患者中的运用。

原始文献来源:  Chang CY,  Chen HA,  Chien YJ,  et al.Attenuation of the increase in intraocular pressure with dexmedetomidine: Systematic review with meta-analysis and trial sequential analysis.[J].J Clin Anesth 2020 Oct 05;68.

Attenuation of the increase in intraocular pressure with dexmedetomidine: Systematic review with meta-analysis and trial sequential analysis

ABSTRACT

Study objective: Whether dexmedetomidine effectively attenuates the increase in intraocular pressure (IOP) remains inconclusive. We aim to evaluate the effects of dexmedetomidine on IOP in adult patients undergoing surgery which requires general anesthesia and endotracheal intubation.

Design: Systematic review and meta-analysis.

Interventions: Intravenous administration of dexmedetomidine during surgery.

Measurements: Intraocular pressure.

Methods: We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, Google Scholar, Wanfang Data, and China National Knowledge Infrastructure from the inception through April 14, 2020. Randomized control trials which involved adult patients undergoing surgery that required general anesthesia and endotracheal intubation, which compared intravenous administration of dexmedetomidine with placebo regarding the IOP levels, which also provided sufficient information for meta-analysis were considered eligible.

Main results: Twenty-nine randomized control trials were included. The IOP levels are significantly lower in patients receiving dexmedetomidine after the administration of dexmedetomidine [mean difference (MD), −2.04 mmHg; 95% confidence interval (CI), −2.40 mmHg to −1.67 mmHg], after the injection of succinylcholine (MD, −3.84 mmHg; 95% CI, −4.80 mmHg to −2.88 mmHg), after endotracheal intubation (MD, −3.64 mmHg; 95% CI, −4.46 mmHg to −2.82 mmHg), after pneumoperitoneum (MD, −3.12 mmHg; 95% CI, −3.93 mmHg to −2.30 mmHg), and after the patients being placed in a steep Trendelenburg position (MD, −4.12 mmHg; 95% CI, −5.39 mmHg to −2.85 mmHg). Trial sequential analyses for these outcomes are conclusive.

Conclusions: Dexmedetomidine effectively attenuates the increase in IOP levels, and should be considered especially for at-risk patients.

  

          贵州医科大学高鸿教授课题组

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