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儿童桃体切除术中的德克斯梅德托米丁:一个系统性审查与元分析
Julia M Olsen1,2, Makoto Sumie1,3,4,5, Alan Yang3
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.
概括
德克斯梅德托米丁 (DEX) 显著降低了接受桃体切除术的儿童的阿片类药物需求和出现痴呆症. 它还降低了手术后恶心和吐的发生率,改善了整体的外科经验.
科学领域:
- 麻醉学和外科手术期间的医学.
- 儿科手术 儿科手术
- 药理学 药理学是指药理学的学科.
背景情况:
- 桃体切除术是一种常见的儿科外科手术程序,与显著的术后疼痛和潜在的不良事件有关.
- 片类止痛药经常使用,但会带来呼吸抑制和恶心/吐的风险.
- 德克斯梅德托米丁 (DEX) 是一种α-2上腺激动剂,具有镇静剂,止痛剂和抗焦虑剂的特性,可以减轻这些问题.
研究的目的:
- 评估静脉注射德克斯梅德托米丁 (DEX) 降低小儿桃体切除术患者外科期阿片类药物需求的疗效.
- 评估DEX对外科手术期间呼吸系统不良事件 (PRAE),突发性妄想 (ED) 和术后恶心和吐 (PONV) 的二次影响.
主要方法:
- 进行了随机对照试验 (RCT) 的系统审查和元分析.
- 包括的研究比较了静脉注射的DEX加上阿片类药物与单独的阿片类药物在接受桃体切除术的儿科患者中.
- 主要结局是外科手术期间的阿片类药物消费 (口服吗啡等价物);次要结局包括PRAE,ED和PONV.
主要成果:
- 德克斯梅德托米丁显著减少了大约40%的外科期阿片类药物需求 (MD, -0.25 mg·kg−1 OME).
- 德克斯与出现狂妄症的发病率较低有关 (RR,0.24),并观察到剂量依赖的减少.
- 虽然DEX没有显著影响咳等呼吸系统不良事件,但它有效地减少了手术后的恶心和吐 (RR,0.48).
结论:
- 静脉注射德克斯梅德托米丁在改善儿科桃体切除术的外科治疗过程方面表现有前途.
- 德克斯有效地降低了阿片类药物消费和出现痴呆症,在痴呆症中具有显著的剂量反应关系.
- 可能需要进一步的研究,以解决报告外科手术期间呼吸系统不良事件的不一致性.
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