尼卡地平用于正颌手术控制性降压的系统评价和Meta分析

摘要

目的:评价尼卡地平用于正颌手术控制性降压的效果.方法:计算机检索英文及中文数据库收集所有相关随机对照试验,2名研究者评价纳入研究质量并提取相关数据,应用Rev Man 5.3.3软件进行数据统计分析.结果:纳入5项RCT,248例患者,Meta分析及定性分析结果显示:尼卡地平组术中出血量显著多于瑞芬太尼组[WMD=43.85,95％ CI (20.52,67.18)],与右美托咪定及硝酸甘油相比无显著差异;输血量各组均无显著差异;尼卡地平控制性降压期间患者心率较降压前显著增快,Q-T间期延长(P＜0.001);使用尼卡地平行控制性降压不影响患者脑氧饱和度及术后神经生理功能;与瑞芬太尼相比,尼卡地平组患者术后尿N-乙酰-β-D-葡萄糖苷酶显著降低(P＜0.05).结论:尼卡地平可有效地达到正颌手术控制性降压要求,可能具有潜在的肾脏保护作用.在减少术中出血方面效果不及瑞芬太尼,可增快患者心率,延长Q-T间期.%Objective:To evaluate the clinical effects of nicardipine for induced controlled hypotension in patients underwent orthognathic surgery.Methods:The related trails were searched from English and Chinese literature databases.The quality of the RCTs was evaluated by 2 indepandent reviewers.The data were statistical analyzed using the Rev Man 5.3.3 software.Results:5 RCTs with 248 patients were included.Meta-analysis and descriptive analysis indicated that blood loss of nicardipine group was more than that of remifentanil group [WMD =43.85,95％ CI(20.52,67.18)].There was no significant difference in blood loss between nicardipine group and dexmedetomidine group and nitroglycerin group.There was no significant difference in transfusion between nicardipine group and the control group.Nicardipine increased the heart rate during controlled hypotension and caused QT prolongation (P ＜ 0.001).Nicardipine had no adverse effects on cerebral oxygen saturation and neurophysiological function.Urinary N-acetyl-1-b-D-glucosaminidase was lower in nicardipine group than that in remifentanil group (P ＜ 0.05).Conclusion:Nicaridpine is effective in the induced controlled hypotension during orthognathic surgery,with potential renal protective effect.However,it is not better than the remifentanil on reducing the blood loss.Nicardipine can increase the heart rate and prolong the QT interval during the controlled hypotension.