Effect of Dexmedetomidine on Intraoperative Hemodynamics and Blood Loss in Patients Undergoing Spine Surgery:A Systematic Review and Meta-Analysis
汪玫 1车建翔 1陈磊 1宋婷婷 1瞿金涛2
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作者信息
1. 麻醉科,中国人民解放军联勤保障部队第925医院,贵阳 550000,中国
2. 骨科,中国人民解放军联勤保障部队第925医院,贵阳 550000,中国
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摘要
目的 右美托咪定是一种高选择性的a2肾上腺素能受体激动剂,具有降低血压和心率的作用.本研究旨在探讨右美托咪定对脊柱手术患者术中血流动力学和失血量的影响.方法检索Web of Science、MEDLINE、EMBASE和Cochrane图书馆截至2023年2月发表的随机对照研究,比较右美托咪定和生理盐水对脊柱手术术中血流动力学和失血量的影响.根据研究间的异质性采用固定或随机效应模型.结果纳入21项随机对照研究,共1388例患者.右美托咪定的使用增加了术中低血压(OR:2.11;95％CI:1.24-3.58;P=0.006)和心动过缓(OR:2.48;95％CI:1.57-3.93;P=0.0001)的总体风险.特别是在给予负荷剂量时,低血压(OR:2.00;95％CI:1.06-3.79;P=0.03)和心动过缓(OR:2.28;95％CI:1.42-3.66;P=0.0007)的风险更为显著.当右美托咪定与静脉麻醉联合使用时,患者更容易出现血流动力学不稳定的情况,包括低血压(OR:2.90;95％CI:1.24-6.82;P=0.01)和心动过缓(OR:2.66;95％CI:1.53-4.61;P=0.0005).与吸入麻醉联合时,仅增加了心动过缓的风险(OR:4.95;95％CI:1.41-17.37;P=0.01).然而,当与静吸复合麻醉联合使用时,并未增加低血压和心动过缓的风险.此外,右美托咪定还增加了重度低血压的风险(OR:2.57;95％CI:1.05-6.32;P=0.04),但对轻度低血压的影响并不显著.对于心动过缓而言,无论是轻度(OR:2.55;95％CI:1.06-6.15;P=0.04)还是重度(OR:2.45;95％CI:1.43-4.20;P=0.001)的风险都有所增加.总体而言,右美托咪定对术中失血量的影响并不显著,但在与吸入麻醉联合时,失血量显著减少(MD:-82.97;95％CI:-109.04--56.90;P＜0.001).结论右美托咪定在脊柱手术过程中增加了低血压和心动过缓的风险.给予负荷剂量或与不同麻醉维持方式联合使用可能会对术中血流动力学和失血量产生不同的影响.然而,目前的研究结果仍需进一步证实和探讨.
Abstract
Objective Dexmedetomidine(Dex)is a highly selective α2 adrenoceptor agonist that reduces blood pressure and heart rate.However,its ability to provide stable hemodynamics and a clinically significant reduction in blood loss in spine surgery is still a matter of debate.This study aimed to investigate the effects of Dex on intraoperative hemodynamics and blood loss in patients undergoing spine surgery.Methods The Web of Science,MEDLINE,EMBASE,and the Cochrane Library were searched up to February 2023 for randomized controlled trials(RCTs)including patients undergoing spine surgeries under general anaesthesia and comparing Dex and saline.A fixed-or random-effect model was used depending on heterogeneity.Results Twenty-one RCTs,including 1388 patients,were identified.Dex added the overall risk of intraoperative hypotension(odds ratio[OR]:2.11;95％confidence interval[CI]:1.24-3.58;P=0.006)and bradycardia(OR:2.48;95％CI:1.57-3.93;P=0.0001).The use of a loading dose of Dex led to significantly increased risks of intraoperative hypotension(OR:2.00;95％CI:1.06-3.79;P=0.03)and bradycardia(OR:2.28;95％CI:1.42-3.66;P=0.0007).For patients receiving total intravenous anesthesia,there was an increased risk of hypotension(OR:2.90;95％CI:1.24-6.82;P=0.01)and bradycardia(OR:2.66;95％CI:1.53-4.61;P=0.0005).For patients in the inhalation anesthesia group,only an increased risk of bradycardia(OR:4.95;95％CI:1.41-17.37;P=0.01)was observed.No significant increase in the risk of hypotension and bradycardia was found in the combined intravenous-inhalation anesthesia group.The incidence of severe hypotension(OR:2.57;95％CI:1.05-6.32;P=0.04),but not mild hypotension,was increased.Both mild(OR:2.55;95％CI:1.06-6.15;P=0.04)and severe(OR:2.45;95％CI:1.43-4.20;P=0.001)bradycardia were associated with a higher risk.The overall analyses did not reveal significant reduction in intraoperative blood loss.However,a significant decrease in blood loss was observed in total inhalation anesthesia subgroup(mean difference[MD]:-82.97;95％CI:-109.04--56.90;P＜0.001).Conclusions Dex increases the risks of intraoperative hypotension and bradycardia in major spine surgery.The administration of a loading dose of Dex and the utilization of various anesthesia maintenance methods may potentially impact hemodynamic stability and intraoperative blood loss.
关键词
右美托咪定/术中血流动力学/失血量/脊柱手术
Key words
dexmedetomidine/intraoperative hemodynamics/blood loss/spine surgery
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基金项目
Science and Technology fund from the Health Commission of Guizhou Province,China(gzwkj2022-389)
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