Meta-analysis of the effects of dexmedetomidine combined with ketamine during dressing changes in burn patients
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摘要: 目的 应用荟萃分析方法系统评价右美托咪定复合氯胺酮在烧伤患者换药过程中应用的安全性与疗效。 方法 以"burns、dexmedetomidine、ketamine、dressing"为检索词检索《PubMed》《Cochrane Central》《Embase》《Web of Science》等外文数据库,以"右美托咪定、氯胺酮、烧伤、烫伤、热力伤、换药"为检索词检索《中国期刊全文数据库》《万方数据库》《中国学术期刊网络出版总库》等中文数据库,检索各数据库自建库起至2019年3月公开发表的关于烧伤患者换药过程中应用右美托咪定复合氯胺酮镇静镇痛的随机对照试验研究。结局指标为给药后5 min收缩压、苏醒躁动评分、氯胺酮用量、换药耗时、体动/苏醒时间、疼痛评分、换药开始10 min及换药后1 h Ramsay镇静评分、医师满意度评分、精神神经症状、恶心呕吐次数、恶心呕吐评分。采用RevMan 5.3和Stata 14.0统计软件对符合标准的研究进行荟萃分析。 结果 共纳入7篇文献396例烧伤患者,包括同时接受右美托咪定和氯胺酮镇静镇痛的右美托咪定+氯胺酮组患者198例、仅接受氯胺酮镇静镇痛的单纯氯胺酮组患者198例。纳入的7项研究偏倚风险均不确定。与单纯氯胺酮组比较,右美托咪定+氯胺酮组患者给药后5 min收缩压、苏醒躁动评分、恶心呕吐评分明显降低,标准化均数差=-13.89、-0.84、-0.99(95%置信区间=-20.89~-6.89、-1.17~-0.52、-1.31~-0.68,
P <0.01);换药开始10 min与换药后1 h Ramsay镇静评分明显升高,标准化均数差=1.53、0.72(95%置信区间=1.05~2.02、0.13~1.31,P <0.05或P <0.01);精神神经症状、恶心呕吐次数明显减少,相对危险度=0.20、0.16(95%置信区间=0.07~0.58、0.05~0.58,P <0.01)。2组患者氯胺酮用量、换药耗时、体动/苏醒时间、疼痛评分、医师满意度评分均相近。换药耗时、氯胺酮用量不存在发表偏倚(P >0.05),其他指标可能存在发表偏倚(P <0.05)。 结论 相较于单纯应用氯胺酮,在烧伤患者换药过程中联合应用右美托咪定与氯胺酮可以减少躁动、恶心呕吐及精神神经等并发症的发生,更好地稳定血压,提升镇静效果。Abstract: Objective To systematically evaluate the safety and efficacy of dexmedetomidine combined with ketamine during dressing changes in burn patients using meta-analysis. Methods Foreign language databases including PubMed, Cochrane Central, Embase, and Web of Science were searched with the terms of " burns, dexmedetomidine, ketamine, and dressing" , and Chinese databases including Chinese Journal Full-Text Database, Wanfang Data, and China Academic Journal Network Publishing Database were searched with the terms in Chinese version of "右美托咪定,氯胺酮,烧伤,烫伤,热力伤,换药" to retrieve the publicly published randomized controlled trials on the application of dexmedetomidine combined with ketamine for sedation and analgesia during dressing changes in burn patients from the establishment of each database to March 2019. The outcome indexes included systolic blood pressure at 5 minutes after administration, arousal restlessness score, ketamine dosage, dressing change time, body movement/recovery time, pain score, Ramsay sedation scores at 10 minutes after the start of dressing change and 1 hour after dressing change, physician satisfaction score, neuropsychological symptoms, nausea and vomiting times, nausea and vomiting score. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results A total of 396 burn patients were included in 7 articles, including 198 patients in dexmedetomidine+ ketamine group who received dexmedetomidine and ketamine for sedation and analgesia, and 198 patients in ketamine alone group who received ketamine alone for sedation and analgesia. The bias risks of the seven studies included were uncertain. Compared with those of ketamine alone group, the systolic blood pressure at 5 minutes after administration, arousal restlessness score, nausea and vomiting score of patients in dexmedetomidine+ ketamine group were significantly decreased, with standardized mean differences of -13.89, -0.84, and -0.99 (95% confidence interval=-20.89--6.89, -1.17--0.52, -1.31--0.68,P <0.01), the Ramsay sedation score at 10 minutes after the start of dressing change and that at 1 hour after dressing change were significantly increased, with standardized mean differences of 1.53 and 0.72 (95% confidence interval=1.05-2.02, 0.13-1.31,P <0.05 orP <0.01), and the number of neuropsychological symptom and number of nausea and vomiting were significantly reduced, with relative risks of 0.20 and 0.16 (95% confidence interval=0.07-0.58, 0.05-0.58,P <0.01). The patients in the two groups were similar in ketamine dosage, dressing change time, body movement/recovery time, pain score, and physician satisfaction score. There was no publication bias in dressing change time or ketamine dosage (P >0.05), while the other indexes might have publication bias (P <0.05). Conclusions Compared with ketamine alone, combination of dexmedetomidine and ketamine during dressing changes in burn patients can reduce the occurrence of restlessness, nausea and vomiting, neuropsychological symptoms, and other complications, better stabilize blood pressure, and enhance sedation effect.-
Key words:
- Burns /
- Ketamine /
- Validation studies /
- Anelgesia /
- Dexmedetomidine /
- Dressing change /
- Systematic evaluation
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