【摘要】：背景:右美托咪定因具有抑制應(yīng)激反應(yīng)、維持血流動力學(xué)穩(wěn)定、無呼吸抑制作用等優(yōu)點,被越來越廣泛的用于ICU鎮(zhèn)靜及圍術(shù)期麻醉的輔助用藥。目前在單肺通氣(OLV)的胸科手術(shù)中使用鹽酸右美托咪定輔助麻醉是否會對肺內(nèi)分流(Qs/Qt)產(chǎn)生影響仍有爭議。目的:通過Meta分析研究單肺通氣的胸科手術(shù)麻醉期間使用鹽酸右美托咪定是否對患者肺內(nèi)分流產(chǎn)生影響,為鹽酸右美托咪定應(yīng)用于單肺通氣胸科手術(shù)提供理論依據(jù)。方法:通過計算機檢索PubMed、The Cochrane Library、Embase、中國生物醫(yī)學(xué)文獻、中國知網(wǎng)、維普中文科技期刊、萬方醫(yī)學(xué)網(wǎng)等數(shù)據(jù)庫,并利用百度和Google搜索工具檢索其它的資料,查找出所有有關(guān)鹽酸右美托咪定應(yīng)用于單肺通氣胸科手術(shù)患者是否會對肺內(nèi)分流產(chǎn)生影響的隨機對照試驗(RCT)文獻,同時對納入文獻的參考文獻進行檢索。對納入的文獻進行質(zhì)量評價及資料提取,并采用RevMan 5.3對各研究指標進行Meta分析。結(jié)果:共納入18個RCT,共計846例患者,其中鹽酸右美托咪定組444例,對照組402例。Meta分析結(jié)果顯示,鹽酸右美托咪定組(D組)與生理鹽水組(N組)在單肺通氣10min的Qs/Qt[WMD=-7.47,95%CI(-9.63~-5.30),p0.00001]、單肺通氣15min的Qs/Qt[WMD=-5.00,95%CI(-8.83~-1.17),p=0.01]、單肺通氣30min的Qs/Qt[WMD=-4.02,95%CI(-6.19~-1.85),p=0.0003]、單肺通氣40min的Qs/Qt[WMD=-3.13,95%CI(-5.47~-0.79),p=0.009]及單肺通氣60min的Qs/Qt[WMD=-3.23,95%CI(-5.23~-1.22),p=0.002]差異有統(tǒng)計學(xué)意義,在單肺通氣90min時的Qs/Qt[WMD=-1.54,95%CI(-3.30~0.23),p=0.09]差異無統(tǒng)計學(xué)意義。結(jié)論:單肺通氣胸科手術(shù)麻醉中經(jīng)靜脈使用鹽酸右美托咪定,可以在一定程度上減少單肺通氣期間的肺內(nèi)分流率,有利于預(yù)防單肺通氣期間因肺內(nèi)分流過大導(dǎo)致的低氧血癥。
[Abstract]:Background: dexmetidine has been widely used in ICU sedation and perioperative anesthesia because of its advantages of inhibiting stress response maintaining hemodynamic stability and no respiratory inhibition. Whether dexmetidine hydrochloride can affect intrapulmonary shunt (Qs/Qt) in thoracic surgery of single lung ventilation (OLV) is still controversial. Objective: to study the effects of dexmetidine hydrochloride on intrapulmonary shunt in patients undergoing single lung ventilation during chest surgery by Meta analysis, and to provide a theoretical basis for the application of dexmetidine hydrochloride in single lung ventilation chest surgery. Methods: PubMed,The Cochrane Library,Embase, Chinese biomedical literature, Chinese knowledge network, Weipu Chinese science and technology journal, Wanfang medical net and other databases were searched by computer, and other data were retrieved by Baidu and Google search tools. To find out all the randomized controlled trial (RCT) literatures about the effect of dexmetidine hydrochloride on intrapulmonary shunt in patients undergoing single lung ventilation and chest surgery, and to search the references included in the literature. The quality evaluation and data extraction of the included literature were carried out, and the Meta analysis of each research index was carried out by RevMan 5.3. Results: a total of 846 patients with RCT, were included, including 444 patients in dexmetomidine hydrochloride group and 402 patients in control group. The results of Meta analysis showed that, Dexmetidine hydrochloride group (group D) and saline group (group N) were treated with Qs/Qt [WMD=-7.47,95%CI (-9.63 ~ -5.30), p 0.00001] in one-lung ventilation 10min. Qs/Qt of one-lung ventilation 15min [WMD=-5.00,95%CI (-8.83 ~ 1.17), p0.01], Qs/Qt of one-lung ventilation 30min [WMD=-4.02,95%CI (-6.19 ~ -1.85), p _ (0.0003)], There were significant differences in Qs/Qt [WMD=-3.13,95%CI (-5.47) -0.79), p0. 009] in 40min and Qs/Qt [WMD=-3.23,95%CI (-5.23-1.22), p0. 002] in single lung ventilation 60min. There was no significant difference in Qs/Qt [WMD=-1.54,95%CI (- 3. 30 鹵0. 23), p0. 09] during single lung ventilation with 90min. Conclusion: intravenous administration of dexmetidine hydrochloride in one-lung ventilation chest surgery anesthesia can reduce intrapulmonary shunt rate in a certain extent and is helpful to prevent hypoxemia caused by excessive intrapulmonary shunt during single-lung ventilation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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