右美托咪定预防小儿心脏手术后交界性异位心动过速和急性肾损伤的疗效：荟萃分析
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Efficacy of dexmedetomidine in prevention of junctional ectopic tachycardia and acute kidney injury after pediatric cardiac surgery: A meta-analysis.
背景与目的
该系统评价在PROSPERO（CRD42017083880）进行注册。从开始到2018年3月，对包括PubMed，Cochrane和Web of Science在内的数据库进行随机对照试验（RCT）和观察性队列研究。两位评价员独立筛选文献，提取数据并评估其质量。使用Jadad量表和纽卡斯尔-渥太华得分的研究。然后由RevMan 5.3和Stata 12.0软件进行Meta分析。 P<.05被认为是有意义的。
方 法
对90例因先天性心脏病行择期心脏手术患儿作前瞻性对照研究。将患儿随机分为2组，I组（右美托咪定组）：60例患儿接受右美托咪定干预；II组(安慰剂组)：30例患儿静脉应用等量生理盐水。
主要结局指标为术后交界性异位性心动过速的发生率，次要结局指标包括心动过缓、低血压、血管活性肌力评分、通气时间、儿科心脏监护病房留滞时间、住院时间和围手术期死亡率。
结 果
共选择了9项符合条件的研究（5项RCT和4项观察性研究），包括1851名患者，进行最终分析。 荟萃分析结果显示右美托咪定显着降低术后JET的发生率（OR = 0.35,95％CI：0.22~0.53，P <.00001），但各组间AKI（OR = 0.87,95％CI：0.35至2.14，P = .77）和所有因素造成的死亡率（OR = 0.44， 95％CI：0.19至1.04，P = .06）的差异无统计学意义。
结 论
围手术期右美托咪定的给药可以有效地防止接受心脏手术的儿科患者的JET，但对术后肾功能没有显着影响。但是，这些发现的证据质量很低;因此，需要进一步的大规模随机研究来验证右美托咪定预防在儿科患者中的真实临床效果。
原始文献摘要
El Amrousy D M, Elshmaa N S, El-Kashlan M, et al. Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery:[J]. J Am Heart Assoc, 2018, 6(3).
OBJECTIVE We conducted a meta-analysis to evaluate the effects of prophylactic perioperative dexmedetomidine administration on postoperative junctional ectopic tachycardia (JET) and acute kidney injury (AKI) in pediatric patients having undergone cardiac surgery.
DESIGN This systematic review was registered with PROSPERO (CRD42017083880). Databases including PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials (RCTs) and observational cohort studies from its inception to March 2018. Two reviewers independently screened literature, extracted data, and assessed the quality of included studies using the Jadad scale and Newcastle-Ottawa score. Meta-analysis was then conducted by RevMan 5.3 and Stata 12.0 software. Pvalue < .05 was considered significant.
RESULTS A total of nine eligible studies (5 RCTs and 4 observational studies) comprising 1851 patients were selected for the final analysis. The results of meta-analysis showed that dexmedetomidine significantly reduced the incidence of postoperative JET (OR =0.35, 95% CI: 0.22 to 0.53, P <.00001), but there was no significant difference between groups in AKI (OR =0.44, 95% CI: 0.19 to 1.04, P = .06) and all-cause mortality (OR =0.87, 95% CI: 0.35 to 2.14, P = .77).
CONCLUSIONS The administration of perioperative dexmedetomidine effectively prevents JET in pediatric patients undergoing cardiac surgery but has no significant effect on postoperative renal function. However, the quality of evidence for these findings is low; thus, future larger scale randomized studies are needed to verify the real clinical effects of dexmedetomidine prophylaxis in pediatric patients.
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编辑：余晓旭 审校：王贵龙