背景:右美托咪定和咪达唑仑是儿童常用的镇静剂。我们进行了系统评价和荟萃分析,以比较右美托咪定联合咪达唑仑与其他镇静剂(包括水合氯醛)提供的镇静的安全性和有效性。咪达唑仑和其他镇静剂在小儿镇静中的应用。
方法:Embase,WebofScience,科克伦图书馆,和PubMed数据库,和Clinicaltrials.gov从开始到2022年6月的对照试验登记册进行了搜索。纳入所有使用右美托咪定-咪达唑仑进行小儿镇静的随机对照试验。文章搜索,数据提取,纳入研究的质量评估由两名研究人员独立进行.镇静成功率被认为是主要结果。次要结果包括镇静起效时间,镇静恢复时间和不良事件的发生。
结果:共筛选了522项研究,确定了6项随机对照试验;分析了859例患者。右美托咪定联合咪达唑仑的镇静成功率较高,CT检查中恶心呕吐发生率较低,磁共振成像,与其他镇静剂相比,听觉脑干反应试验或纤维支气管镜检查检查(OR=2.92;95%CI:1.39-6.13,P=0.005,I2=51%;OR=0.23,95%CI:0.07-0.68,P=0.008,I2=0%,分别)。两组患者在恢复时间和不良反应发生方面差异无统计学意义(WMD=-0.27,95%CI:-0.93~-0.39,P=0.42;OR0.70;95%CI:0.48~1.02,P=0.06,I2=45%。分别)。然而,对ASAI-II型儿童的亚组分析结果显示,右美托咪定-咪达唑仑组的起效时间比其他镇静剂快(WMD=-3.08;95%CI:-4.66~-1.49,P=0.0001,I2=30%).
结论:这项荟萃分析表明,与对照组相比,右美托咪定联合咪达唑仑组的镇静成功率更高,在完成检查时恶心呕吐的发生率更低,表明前瞻性门诊临床应用于程序镇静。
BACKGROUND: Dexmedetomidine and
midazolam are commonly used sedatives in children. We conducted a systematic review and meta-analysis to compare the safety and effectiveness of sedation provided by dexmedetomidine combined with
midazolam versus other sedatives including chloral hydrate,
midazolam and other sedatives in pediatric sedation.
METHODS: The Embase, Web of Science, Cochrane Library, and PubMed databases, and Clinicaltrials.gov register of controlled trials were searched from inception to June 2022. All randomized controlled trials used dexmedetomidine-
midazolam in pediatric sedation were enrolled. The articles search, data extraction, and quality assessment of included studies were performed independently by two researchers. The success rate of sedation was considered as the primary outcome. The secondary outcomes included onset time of sedation, recovery time of sedation and occurrence of adverse events.
RESULTS: A total of 522 studies were screened and 6 RCTs were identified; 859 patients were analyzed. The administration of dexmedetomidine combined with
midazolam was associated with a higher sedation success rate and a lower incidence of nausea and vomiting in computed tomography, magnetic resonance imaging, Auditory Brainstem Response test or fiberoptic bronchoscopy examinations than the other sedatives did (OR = 2.92; 95% CI: 1.39-6.13, P = 0.005, I2 = 51%; OR = 0.23, 95% CI: 0.07-0.68, P = 0.008, I2 = 0%, respectively). Two groups did not differ significantly in recovery time and the occurrence of adverse reactions (WMD = - 0.27, 95% CI: - 0.93 to - 0.39, P = 0.42; OR 0.70; 95% CI: 0.48-1.02, P = 0.06, I2 = 45%. respectively). However, the results of the subgroup analysis of ASA I-II children showed a quicker onset time in dexmedetomidine-midazolam group than the other sedatives (WMD=-3.08; 95% CI: -4.66 to - 1.49, P = 0.0001, I2 = 30%).
CONCLUSIONS: This meta-analysis showed that compared with the control group, dexmedetomidine combined with midazolam group provided higher sedation success rates and caused a lower incidence of nausea and vomiting in completing examinations, indicating a prospective outpatient clinical application for procedural sedation.