右美托咪定在膝关节镜手术疼痛管理中的应用：系统评价与Meta分析
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Efficacy of dexmedetomidine for pain management in knee arthroscopy: A systematic review and meta-analysis
背景与目的
右美托咪定在膝关节镜手术患者疼痛控制中具有一定的潜在优势。为了解右旋美托咪啶在膝关节镜手术患者中的疗效，我们进行了这项系统评价和Meta分析
方 法
我们在PubMed、Embase、Web of Science、EBSCO、Cochrane图书馆数据库搜索了关于右美托咪定对膝关节镜手术疗效评价的随机对照试验(RCTs) ，主要结局指标为疼痛评分。采用随机效应模型进行Meta分析
结 果
最终纳入5项RCTs。总体而言，与膝关节镜手术患者相比，右美托咪定可显著降低疼痛评分（均值标准差= -0.84; 95% CI= -1.24 to -0.44; P <.0001）和术后双氯芬酸钠用量（均值标准差= -1.76; 95% CI= -3.32 to -0.21; P = .03），提高镇痛效果的持续时间（均值标准差= 1.78; 95% CI= 0.56-3.00; P = .004），但对低血压（危险比RR= 0.93; 95%CI = 0.14-5.92; P =.94）、心动过缓（RR = 4.93; 95% CI = 0.91-26.58; P = .06）、恶心呕吐（RR = 1.96; 95% CI = 0.31-12.58; P = .48）的发生无影响。
结 论
右美托咪定干预能显著降低疼痛评分和术后双氯芬酸钠用量并提高膝关节镜手术患者镇痛效果的持续时间，但对低血压、心动过缓、恶心呕吐的发生没有影响。
原始文献摘要
Li C1, Qu J. Medicine (Baltimore). 2017 Oct;96(43):e7938.
BACKGROUND:
Dexmedetomidine showed some potential in pain control in patients undergoing knee arthroscopy. We conducted a systematic review and meta-analysis to explore the efficacy of dexmedetomidine in patients undergoing knee arthroscopy.
METHODS:
We searched the randomized controlled trials (RCTs) assessing the effect of dexmedetomidine on knee arthroscopy in PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases. The primary outcome was pain scores. Meta-analysis was performed using the random-effect model.
RESULTS:
Five RCTs were included. Overall, compared with control intervention in patients with knee arthroscopy, dexmedetomidine intervention could significantly reduce the pain scores [Std. mean difference = -0.84; 95% confidence interval (95% CI) = -1.24 to -0.44; P < .0001] and postoperative diclofenac sodium consumption (Std. mean difference = -1.76; 95% CI = -3.32 to -0.21; P = .03), improve duration of analgesic effect (Std. mean difference = 1.78; 95% CI = 0.56-3.00; P = .004), but showed no influence on hypotension [risk ratio (RR) = 0.93; 95% CI = 0.14-5.92; P = .94], bradycardia (RR = 4.93; 95% CI = 0.91-26.58; P = .06), nausea, and vomiting (RR = 1.96; 95% CI = 0.31-12.58; P = .48).
CONCLUSION:
Dexmedetomidine intervention was able to significantly reduce the pain scores and postoperative diclofenac sodium consumption, and improve duration of analgesic effect in patients undergoing knee arthroscopy, but had no influence on hypotension, bradycardia, nausea, and vomiting.
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