中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (12): 1951-1958.doi: 10.3969/j.issn.2095-4344.3780

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

臂丛神经阻滞中应用右美托咪定联合局部麻醉药的系统评价和meta分析

王  韶1,原大江2,李艳艳1,李小雅1     

  1. 1山西医科大学麻醉学系,山西省太原市   030000; 2山西医科大学第二医院重症医学科,山西省太原市   030000
  • 收稿日期:2020-05-09 修回日期:2020-05-12 接受日期:2020-05-27 出版日期:2021-04-28 发布日期:2020-12-26
  • 通讯作者: 中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程
  • 作者简介:王韶,1993年生,女,河北省保定市人,汉族,山西医科大学在读硕士,主要从事伤害信号转导和器官损伤保护的相关研究。

Dexmedetomidine combined with local anesthetic for brachial plexus block: a systematic review and meta-analysis

Wang Shao1, Yuan Dajiang2, Li Yanyan1, Li Xiaoya1   

  1. 1Department of Anesthesiology, Shanxi Medical University, Taiyuan  030000, Shanxi Province, China; 2Department of Critical Medicine, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • Received:2020-05-09 Revised:2020-05-12 Accepted:2020-05-27 Online:2021-04-28 Published:2020-12-26
  • Contact: Yuan Dajiang, MD, Chief physician, Department of Critical Medicine, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • About author:Wang Shao, Master candidate, Department of Anesthesiology, Shanxi Medical University, Taiyuan 030000, Shanxi Province, China

摘要:

文题释义:
镇痛持续时间:局部麻醉药物注射完毕到第一次给予镇痛药之间的时间间隔。
运动阻滞持续时间:局部麻醉药注射完毕到神经阻滞恢复之间的时间间隔。

目的:目前关于右美托咪定在臂丛神经阻滞中效果的研究样本量小且研究结果不一致。文章采用Meta分析方法评估右美托咪定联合局部麻醉药在臂丛神经阻滞中的效果。
方法:在PubMed、Embase、Cochrane Library、中国知网、万方医学网和维普数据库中,根据右美托咪定、臂丛神经阻滞等关键词检索相关文献,检索截止时间为从建库到2019年12月。纳入的研究类型为临床随机对照试验,对象为18岁以上接受臂丛神经阻滞的患者,采用右美托咪定联合局部麻醉药干预,由2名研究者独立筛选文献。采用Cochrane系统评价手册进行文献质量评价,采用 RevMan 5.3 软件进行Meta分析。主要结局指标包括镇痛持续时间和运动阻滞持续时间,次要结局指标为不良事件。分别采用加权均数差 (WMD)和相对危险度(RR)作为合并效应量。
结果:①共纳入24篇文献,样本量1 612例,有1篇文献未提及随机方法,有11篇未提及分配隐藏,有6篇未提及盲法;②右美托咪定无论神经周围(WMD=182.91,95%CI:129.85-235.96,P < 0.001)或静脉应用(WMD=180.47,95%CI:83.01-277.93, P=0.000 3)均能延长镇痛持续时间;神经周应用还能延长运动阻滞持续时间(WMD=147.57,95%CI:120.81-174.33,P < 0.001);③与静脉组相比,神经周组在延长镇痛持续时间(WMD=69.24,95%CI:24.92-113.56,P=0.002)和运动阻滞持续时间(WMD=74.35,95%CI:47.68-101.01,P < 0.001)方面更具优势;④应用右美托咪定后,患者出现最多的不良事件是心动过缓(RR=5.08,95%CI:3.25-7.93,P < 0.001)。
结论:右美托咪定联合局部麻醉药能显著延长臂丛神经阻滞作用时间,但同时增加心动过缓发生率。在镇痛持续时间和运动阻滞持续时间方面,臂丛神经周围给药优于静脉给药途径。但文章也存在异质性高及纳入文献质量偏低的缺点,所以未来仍需要更多大规模多中心的高质量随机对照试验来进一步验证。

https://orcid.org/0000-0002-6378-9294 (王韶) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 麻醉, 臂丛, 镇痛, 阻滞, 静脉, 给药途径, Meta分析, 系统评价

Abstract: OBJECTIVE: The current research sample on the effect of dexmedetomidine in brachial plexus block is small and the results are inconsistent. Meta-analysis was used to evaluate the effect of dexmedetomidine combined with local anesthetics on brachial plexus block.
METHODS: In PubMed, Embase, Cochrane Library, CNKI, Wanfang Medical Network, and VIP database, the authors searched for related literature published from inception to December 2019 based on keywords such as dexmedetomidine, and brachial plexus block. The type of study included was clinical randomized controlled trials. The subjects were patients over 18 years old who received brachial plexus blockade. The intervention was dexmedetomidine combined with local anesthetics. Two researchers independently screened the literature. The Cochrane systematic review manual was used for literature quality evaluation, and Revman5.3 software was used for meta-analysis. The main outcome measures included the duration of analgesia and the duration of exercise block, and the secondary outcome measure was adverse events. Weighted mean difference and relative risk were used as the combined effects.
RESULTS:  (1) A total of 24 articles were included, with 1 612 samples. One article did not mention randomness, 11 did not mention allocation concealment, and 6 did not mention blind method. (2) Both perineural (WMD=182.91, 95%CI:129.85-235.96, P < 0.001) and intravenous dexmedetomidine (WMD=180.47, 95%CI:83.01-277.93, P=0.000 3) could effectively prolong analgesic duration. Perineural application could also extend the duration of motor block (WMD=147.57, 95%CI:120.81-174.33, P < 0.001). (3) Compared with the intravenous group, the perineural group had an advantage in extending the duration of analgesia (WMD=69.24, 95%CI:24.92-113.56, P=0.002) and the duration of motor block (WMD=74.35, 95%CI:47.68-101.01, P < 0.001). (4) After applying dexmedetomidine, the most common adverse event was bradycardia (RR=5.08, 95%CI:3.25-7.93, P < 0.001). 
CONCLUSION: Dexmedetomidine combined with local anesthetic can significantly prolong the duration of brachial plexus block, but simultaneously increase the incidence of bradycardia. In terms of duration of analgesia and duration of exercise block, peri-brachial plexus administration is superior to intravenous administration. However, this article also has the shortcomings of high heterogeneity and low quality of the included literature. Therefore, more large-scale multicenter high-quality randomized controlled trials are still needed for further verification in the future.


Key words: anesthesia, brachial plexus, analgesia, block, intravenous, administration route, meta-analysis, systematic review

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