本文選題：藥物 + 全身麻醉��； 參考：《廣州醫(yī)科大學》2014年碩士論文

【摘要】：目的:通過Meta分析的方法評價各種藥物在預防全身麻醉后寒戰(zhàn)方面的效能" 方法:以“drug, general anesthesia and shiver or rigor”為檢索詞檢索PubMed、Springer、Sciencedirect、Ovid數(shù)據(jù)庫，以“藥物、全身麻醉、寒戰(zhàn)”為檢索詞檢索維普期刊全文數(shù)據(jù)庫、萬方數(shù)據(jù)庫、中國期刊網(wǎng)（CNKI）、中國生物醫(yī)學文獻數(shù)據(jù)庫（CBM），檢索時間截止至2014年2月，限中英文語種，并手動或計算機檢索相關雜志。根據(jù)需要制定嚴格的文獻納入標準和文獻剔除標準，納入所有藥物預防全身麻醉后寒戰(zhàn)方面的隨機對照試驗,對獲得2篇以上相關措施的全文文獻進行Meta分析。納入研究的質(zhì)量評價方法采用修正后的Jadad評分量表和隨機分配隱藏方案,兩名獨立人員提取相關資料和數(shù)據(jù),并繪制表格。采用Revman5.2軟件對寒戰(zhàn)發(fā)生情況進行數(shù)據(jù)處理和分析,結(jié)果采用優(yōu)勢比(odds ratio, OR)和95%可信區(qū)間(confidence interval, el)表示,并繪制森林圖(forest plot)。以I40%和P0.1作為檢驗異質(zhì)性(heterogeneity)的統(tǒng)計量標準。繪制漏斗圖(funnel plot)和計算失安全系數(shù)(fale-safe number,Nfs)來評估結(jié)果是否受發(fā)表偏倚的影響,并根據(jù)各納入文獻的特征對結(jié)果進行敏感性分析。 結(jié)果:共有39篇文獻最終確定進入本文作為Meta分析原始數(shù)據(jù)。其中右美托咪定11篇、可樂定4篇；中樞性興奮藥多殺普倫2篇；曲馬多8篇，帕瑞昔布鈉3篇，奈福泮、地佐辛各2篇，地塞米松、地西拉嗪、替扎尼定、芬太尼、哌替啶、氯胺酮、歐貝各1篇,納入的文獻方法學質(zhì)量相對較高。對各藥物獲得2篇以上全文文獻,分別進行Meta分析,共計26篇。整體分析的結(jié)果顯示,帕瑞昔布鈉、曲馬多、右美托咪定、可樂定均可有效降低全身麻醉后寒戰(zhàn)的發(fā)生。結(jié)果分別為(p0.005,OR=0.14,95%CI為0.04-0.54)、(p0.00001,OR=0.13,95%CI為0.08-0.22)，（p 0.00001,OR=0.13,95%CI為0.09-0.21）。對納入的研究按照干預時間的不同進行亞組分析，結(jié)果表明曲馬多在術畢、麻醉誘導前給予對全身麻醉后寒戰(zhàn)的預防均有效，，結(jié)果分別為（p=0.0003,OR=0.16,95%CI為0.06-0.44， p=0.69， I=0%；p0.00001,OR=0.04,95%CI為0.01-0.13，p=0.4，I=0%)，對所納入研究按照干預措施的不同進行亞組分析，結(jié)果表明，右美托咪定在手術結(jié)束前30min給予，麻醉誘導前單次給予，麻醉誘導前單次給予復合劑量并持續(xù)給予麻醉維持對全身麻醉后寒戰(zhàn)的預防均有效，結(jié)果分別為（p0.00001,OR=0.10,95%CI為0.04-0.28，p=0.54，I=0%；p=0.0007,OR=0.07,95%CI為0.01-0.32，p=0.46，I=0%；p0.00001, OR=0.17,95%CI為0.08-0.34，p=0.70，I=0%）。 結(jié)論：帕瑞昔布鈉、曲馬多、右美托咪定、可樂定均可有效降低全身麻醉后寒戰(zhàn)的發(fā)生。
[Abstract]:Objective: to evaluate the efficacy of various drugs in preventing shivering after general anesthesia by means of Meta analysis. Methods: using "general, general anesthesia and shiver or rigor" as the key word to search the database of PubMeder Spring Science Direction Ovid, using "drugs, General Anesthesia, shivering" as the key word to search the full text database of Weip journal and the database of Wancang, and to search the database of "drug, general anesthesia, shivering" as the key word. CNKI, China Biomedical Literature Database (CBM). The search time is up to February 2014. The search time is limited to Chinese and English languages, and related journals are searched manually or by computer. According to the need to establish strict standards of literature inclusion and elimination, to include all drugs in the prevention of cold after general anesthesia randomized controlled trial, to obtain more than two related measures of the full text of the Meta analysis. The quality evaluation method included in the study was a modified Jadad rating scale and a random allocation scheme. Two independent personnel extracted the relevant data and data and drew the table. Revman5.2 software was used to process and analyze the occurrence of shivering. The results were expressed by odds odds ratio (OR) and 95% confidence confidence interval.forest maps were plotted. I 40% and P 0. 1 were used as statistical criteria to test heterogeneity. Funnel plotand fale-safe number Nfs) were used to evaluate whether the results were affected by publication bias, and the sensitivity of the results was analyzed according to the characteristics of the literatures involved. Results: a total of 39 articles were finally identified as raw data for Meta analysis in this paper. Of these, 11 were dexmetomidine, 4 clonidine; 2 were central stimulators, 8 were tramadol, 3 were paroxib sodium, 2 were nafopam, 2 were diazoside, 2 were dexamethasone, diceprazine, tezanidine, fentanyl, pethidine, Ketamine, Obeb, 1 each, included a relatively high quality of literature methodology. More than 2 articles were obtained from each drug, and 26 articles were analyzed by Meta. Overall analysis showed that paroxib sodium tramadol dexmetomidine and clonidine could significantly reduce the incidence of shivering after general anesthesia. The results were as follows: 0.1495 CI (0.04-0.54) and 0.1395 CI (0.08-0.22). The CI values were 0.09-0.21 (P 0.00001) and 0.09-0.21 (CI = 0.09-0.21) respectively. The subgroup analysis of the included study according to the time of intervention showed that tramadol was effective in preventing shivering after general anesthesia at the end of operation and before induction of anesthesia. The results showed that the CI was 0.06-0.44, p0.69, and 0.01-0.13 respectively. The CI was 0.01-0.13, and the CI was 0.01-0.13. The subgroup analysis was carried out according to the intervention measures. The results showed that dexmetomidine was given only once before anesthesia induction. A single dose of compound dose before induction and continuous maintenance of anesthesia were effective for the prevention of shivering after general anesthesia. The results were as follows: 0.1095 CI was 0.04-0.28p0.54I0, and the CI was 0.01-0.32p0.46I00.001, and 0.1795CI was 0.08-0.34p0.701. Conclusion: pareoxib sodium, tramadol, dexmetomidine and clonidine can effectively reduce the incidence of shivering after general anesthesia.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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