减少全麻气管插管导致咳嗽发生风险的药物
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Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis
背景与目的
全麻气管插管导致的咳嗽可对患者造成不利的结局，但目前尚不清楚哪种药物对减少这种情况最有效。本研究对随机对照试验进行了系统回顾和荟萃分析，以确定药物对减少全身麻醉后突发性咳嗽的相对疗效。所研究的药物有利多卡因（静脉注射、皮下注射、局部或气管内使用）、右美托咪定、瑞芬太尼和芬太尼。
方 法
我们搜索了8个不同的医学文献数据库、会议摘要和相关参考文献。筛选后，对收录的引文进行偏倚评估，并提取数据。综合评估每个研究比较的合并优势比和95%可信区间。累积曲线分析（SUCRA）下的面积确定减少突发性咳嗽的每个干预措施的有效性。亚组分析包括严重咳嗽、拔管次数、麻醉维持方式和药物剂量。
结 果
本荟萃分析包括70项研究，5286名患者。所有研究中的药物在减少拔管期中、重度咳嗽方面都比不使用药物或安慰剂有效。右美托咪定的SUCRA等级最高，其次是瑞芬太尼、芬太尼和利多卡因（气管内、皮下/局部和静脉途径）。瑞芬太尼仅在减少严重咳嗽方面排名最高。与安慰剂、右美托咪定、芬太尼和瑞芬太尼相比，气管内利多卡因使用延长拔管时间的几率更高。
结 论
所有研究药物在减轻中重度突发性咳嗽方面均优于安慰剂或无药物治疗，其中以右美托咪定最有效。
原始文献摘要
Tung A, Fergusson NA, Ng N, Hu V, Dormuth C, Griesdale DEG. Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis. Br J Anaesth. 2020 Feb 22. pii:S0007-0912(20)30012-X.doi:10.1016/j.bja.2019.12.041. PubMed PMID: 32098647.
BACKGROUND:Emergence coughing can harm the patient following completion of surgery, but it is unclear which medication is most effective at reducing this event. We conducted a systematic review and network meta-analysis of RCTs to determine the medications' relative efficacies on decreasing moderate to severe emergence coughing after general anaesthesia. Medications studied were lidocaine (i.v., intracuff, topical, or tracheal application), dexmedetomidine, remifentanil, and fentanyl.
METHODS:We searched eight different medical literature databases, conference abstracts, and article references. After screening, included citations were evaluated for bias and had their data extracted. Pooled odds ratios and 95% confidence intervals for each treatment comparison were calculated. A surface under the cumulative ranking curve analysis (SUCRA) determined the relative rank of each intervention to decrease moderate to severe emergence coughing. Subgroup analyses included severe coughing only, extubation times, type of maintenance anaesthetic, and dosages.
RESULTS:The network meta-analysis included 70 studies and 5286 patients. All study medications had favourable odds in reducing moderate and severe peri-extubation coughing compared with either no medication or placebo. No single medication was favoured over another. Dexmedetomidine had the highest SUCRA rank, followed in order by remifentanil, fentanyl, and lidocaine via intracuff, tracheal/topical, and i.v. routes. Remifentanil was ranked highest for decreasing severe coughing only. Intracuff lidocaine had higher odds of prolonging extubation times compared with placebo, dexmedetomidine, fentanyl, and remifentanil.
CONCLUSION:All study medications were better than placebo or no medication in reducing moderate to severe emergence cough, with dexmedetomidine ranked the most effective.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：冯玉蓉 审校：王贵龙