摘要目的 采用Meta分析的方法 比较右美托咪定(dexmedetomidine,Dex)与艾司洛尔(esmolol,Esm)辅助用于全身麻醉患者术中控制性降压的优缺点.方法 计算机检索PubMed、EMBASE、Medline、Cochrane Library、Web of Science、CBM、CKNI、万方及维普等电子数据库,检索时间从建库至2017年5月,收集所有有关Dex和Esm辅助用于全身麻醉患者术中控制性降压对比研究的随机对照试验(ramdomized controlled trial,RCT),严格按照Cochrane指导手册评价文献质量,并采用RevMan 5.3软件进行Meta分析.结果 最终纳入10篇RCT,共计568例患者.Meta分析结果 显示:Esm组与Dex组在降压成功率[相对危险度(risk ratio,RR)=1.04,95％CI(1.00,1.08)]、术野质量评分≤2分的人数[RR=1.01,95％CI (0.94,1.09)]、术野质量评分[加权均数差(weighted mean difference,WMD)=-0.12,95％CI(-0.28,0.03)]之间的差异无统计学意义(P＞0.05);Dex组术中芬太尼用量更少[WMD=-38.85,95％CI(-49.66,-28.05)],苏醒时间[WMD=4.11,95％CI(2.57,5.66)]和术后首次需镇痛药时间[WMD=29.89,95％CI (22.61,37.17)]更长,术后恶心呕吐发生率更低[RR=0.41,95％CI (0.18,0.93)](P＜0.05).结论 全身麻醉中辅助应用Dex和Esm行控制性降压安全可行;Dex在节省术中镇痛药、延长术后镇痛时间及减少术后恶心呕吐方面优于Esm,但可能稍延长苏醒时间.

abstractsObjective To assess the advantages and disadvantages of using dexmedetomidine (Dex) or esmolol (Esm) respectively in controlling hypotension during general anesthesia in operation by Meta-analysis.Methods We searched all randomized controlled trial (RCT) relating to controlled hypotension with Dex or Esm during general anesthesia in online database of PubMed,EMBASE,Medline,Cochrane Library,Web of Science,CBM,CKNI,Wangfang Data Resource and VIP.The quality of trials was strictly assessed according to the Cochrane Collaboration manual.RevMan 5.3 software was used for data analysis.Results Ten RCT with 568 cases were included.Meta-analysis showed that there were no significant statistically differences between the two groups on the achievement ratio of controlled hypotension [risk ratio (RR) =1.04,95％(confidence interva,CI)(1.00,1.08)],the number of patients with surgical field score≤2 [RR=1.01,95％CI (0.94,1.09)] and the surgical field scores [weighted mean difference (WMD) =-0.12,95％CI (-0.28,0.03)] (P＞0.05).Dex group needed less dose of fentanyl in operation [WMD=-38.85,95％CI (-49.66,-28.05)],but the time to first analgesic request [WMD=29.89,95％CI (22.61,37.17)] and recovery time [WMD=4.11,95％CI (2.57,5.66)] in this group were longer.Also there is less incidence of postoperative nausea or vomiting in Dex group [RR=0.41,95％CI (0.18,0.93)] (P＜0.05).Conclusions Dex and Esm are both safe drugs for controlling hypotension during general anesthesia in operation.Dex may have better effect on reducing general anesthetics in operation,reducing pain of post-operation and decreasing incidence of postoperative nausea or vomiting happened on patients.But it may lead to delay of regaining conscious of patients.