目的:系统评价盐酸右美托咪定用于慢性阻塞性肺疾病(COPD)急性期的有效性和安全性,以为临床提供循证参考。方法:计算机检索中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库、PubMed、Cochrane 图书馆和EMBase,收集盐酸右美托咪定(试验组)对比空白对照或咪达唑仑(对照组)用于COPD急性期有效性和安全性的随机对照试验(RCT),对符合纳入标准的临床研究进行资料提取,并采用Cochrane系统评价员手册5.1.0进行质量评价,采用Rev Man 5.1统计软件进行Meta分析。结果:共纳入6项RCT,合计285例患者。Meta分析结果显示,试验组患者的机械通气时间[MD=-1.52,95%CI(-2.05,-1.00),P<0.001]、重症监护病房(ICU)滞留时间[MD=-1.10,95%CI(-1.60,-0.60),P<0.001]均显著短于对照组,谵妄发生率[OR=0.20,95%CI(0.09,0.43),P<0.001]低于对照组,差异均有统计学意义;两组患者心血管不良反应发生率比较,差异无统计学意义[MD=0.85,95%CI(0.38,1.90),P=0.70]。结论:盐酸右美托咪定可减短COPD急性期患者的机械通气时间、ICU滞甾时间,且安全性较好。
Abstract
OBJECTIVE: To systematically review the effiectiveness and safety of dexmedetomidine hydrochloride in chronic obstructive pulmonary disease (COPD) in acute phase, and provide evidence-based reference for clinical treatment. METHODS: Retrieved from CJFD, CBM, VIP, PubMed, Cochrane Library and EMBase, randomized controlled trials (RCT) about the effiectiveness and safety of dexmedetomidine hydrochloride(test group) versus blank control or Midazolan(control group) in COPD in acute phase were collected. Meta-analysis was performed by using Rev Man 5.1 software after data extract and quality evaluation by Cochrone 5.1.0. RESULTS: Totally 6 RCT were enrolled, involving 285 patients. Results of Meta-analysis showed, duration of mechanical ventilation [MD=-1.52,95%CI(-2.05,-1.00),P<0.001] and ICU residence time [MD=-1.10,95%CI(-1.60,-0.60),P<0.001] in test group were significantly shorten than control group, incidence of delirium was lower than control group [OR=0.20,95%CI(0.09, 0.43),P<0.001], the difference was statistically significant; and there was no significant difference in the incidence of cardiovascular adverse reactions between 2 groups [MD=0.85,95%CI(0.38,1.90),P=0.70]. CONCLUSIONS:Dexmedetomidine hydrochloride can significantly reduce duration of mechanical ventilation and ICU residence time of COPD in acute phase,with good safety.