■心房颤动是最常见的快速性心律失常,导管消融是房颤的有效治疗方法。然而,过程中可能会出现疼痛和紧张。此外,对于在这些手术中使用哪种镇痛剂和镇静剂最好,仍未达成共识。因此,我们进行了一项网络荟萃分析,以评估用于心房颤动导管消融术的镇痛药和镇静剂的疗效和安全性.
■我们搜索了PubMed,科克伦图书馆,WebofScience,EMBASE,中国国家知识基础设施,和百度文库文档下载网站,用于随机对照试验从开始到2023年2月26日。仅包括在镇痛药或镇静剂之间进行比较并涉及接受射频导管消融的房颤患者的研究。疗效终点为房颤射频导管消融期间Ramsay镇静评分和视觉模拟量表评分。安全性终点是呼吸抑制的发生率,低血压,恶心,和呕吐。进行了成对比较和频率方法分析。结果报告为比值比(OR),平均差(MD),和相应的95%置信区间(CI)。我们根据Cochrane干预措施系统评价手册评估了研究的风险偏倚。
■在最初检索到的709篇文章中,14项研究,共有1156名参与者,包括在内。就功效而言,在房颤射频消融术期间接受右美托咪定的患者的Ramsay镇静评分高于接受咪达唑仑加芬太尼的患者,或其衍生物(MD-0.88,95%CI[-0.04至-0.72])。与吗啡相比,地佐辛(MD1.88,95%CI[1.16至2.60]),氢吗啡酮(MD4.07,95%CI[3.56至4.58]),布托啡诺(MD3.18,95%CI[2.38至3.96]),芬太尼或其衍生物(MD1.57,95%CI[1.25to1.89])具有较好的镇痛效果。在安全方面,与右美托咪定加芬太尼或其衍生物相比,丙泊酚(OR16.46;95%CI[1.54,175.95])和咪达唑仑加芬太尼或其衍生物(OR7.02;95%CI[1.33,36.99])显著增加了呼吸抑制的发生率。与单独使用芬太尼相比,右美托咪定加芬太尼或其衍生物可降低恶心和呕吐的发生率(OR4.74;95%CI[1.01,22.22])。丙泊酚的恶心和呕吐发生率低于氢吗啡酮(OR0.01;95%CI[0.00~0.59])和芬太尼或其衍生物(OR0.01;95%CI[0.00~0.51])。任何两种策略之间的低血压发生率均无统计学差异。
■氢吗啡酮和布托啡诺的镇痛效果优于芬太尼或其衍生物。右美托咪定有较好的镇静效果。在安全方面,右美托咪定,羟吗啡酮,和布托啡诺优越。有必要探索在心房颤动(AF)射频消融术中同时考虑有效性和安全性的方案。
■这项研究在PROSPERO注册,编号:CRD42023403661。
UNASSIGNED: Atrial fibrillation is the most common tachyarrhythmia, while catheter ablation is an effective therapy for atrial fibrillation. However, pain and nervousness may occur during the procedure. Moreover, a consensus has still not been reached on which is the best kind of analgesic and sedative to use in these procedures. Therefore, we conducted a network meta-analysis to evaluate the efficacy and safety of analgesics and sedatives used in catheter ablation for atrial fibrillation.
UNASSIGNED: We searched PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure, and Baidu Wenku document download website for randomized controlled trials from their inception to February 26, 2023. Only studies that made comparisons among analgesics or sedatives and involved patients with atrial fibrillation undergoing radiofrequency catheter ablation were included. The efficacy endpoints were Ramsay sedation scores and visual analog scale scores during the radiofrequency catheter ablation for atrial fibrillation. The safety endpoints were the incidence of respiratory depression, hypotension, nausea, and vomiting. Pairwise comparisons and frequency method analyses were conducted. Results were reported as odds ratio (OR), mean difference (MD), and corresponding 95% confidence intervals (CIs). We assessed the risk bias of the studies in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.
UNASSIGNED: Out of the 709 articles initially retrieved, 14 studies, with a total of 1156 participants, were included. In terms of efficacy, patients receiving dexmedetomidine during radiofrequency ablation for atrial fibrillation had higher Ramsay sedation scores than those receiving midazolam plus fentanyl, or its derivatives (MD -0.88, 95% CI [-0.04 to -0.72]). Compared with morphine, dezocine (MD 1.88, 95% CI [1.16 to 2.60]), hydromorphone (MD 4.07, 95% CI [3.56 to 4.58]), butorphanol (MD 3.18, 95% CI [2.38 to 3.96]), and fentanyl or its derivatives (MD 1.57, 95% CI [1.25 to 1.89]) had a better analgesic effect. In terms of safety, propofol (OR 16.46; 95% CI [1.54 to 175.95]) and midazolam plus fentanyl or its derivatives (OR 7.02; 95% CI [1.33 to 36.99]) significantly increased the incidence of respiratory depression compared with dexmedetomidine plus fentanyl or its derivatives. Dexmedetomidine plus fentanyl or its derivatives reduced the incidence of nausea and vomiting compared with fentanyl alone (OR 4.74; 95% CI [1.01 to 22.22]). Propofol was associated with a lower incidence of nausea and vomiting than hydromorphone (OR 0.01; 95% CI [0.00 to 0.59]) and fentanyl or its derivatives (OR 0.01; 95% CI [0.00 to 0.51]). There was no statistically significant difference in the incidence of hypotension between any two strategies.
UNASSIGNED: Hydromorphone and butorphanol had better analgesic effects than fentanyl or its derivates. Dexmedetomidine had better sedative effects. In terms of safety, dexmedetomidine, oxymorphone, and butorphanol were superior. It is necessary to explore the regimen that can consider both the effectiveness and safety during radiofrequency catheter ablation for atrial fibrillation (AF).
UNASSIGNED: This study was registered with PROSPERO, number: CRD42023403661.