摘要
目的研究舒芬太尼(sufentanil)与芬太尼(fentanil)对重症患者机械通气血流动力学的影响。方法计算机检索PubMed、The Cochrane Library、CNKI、VIP及WanFang Data数据库,查找比较舒芬太尼与芬太尼对重症患者机械通气血流动力学影响的随机对照试验(RCT),检索时限为建库至2018年4月25日。同时手检纳入文献的参考文献。按纳入与排除标准由两人独立进行文献的筛选、资料提取和质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入11个研究,舒芬太尼组307例,芬太尼组302例。Meta分析结果显示:舒芬太尼组较对照组插管后收缩压低[MD=-10.51,95%CI (-20.50,-0.53), P=0.04];舒芬太尼组平均动脉压较对照组高[MD=7.86, 95%CI(5.37,10.34),P<0.01];舒芬太尼组插管后心率较对照组低[MD=-7.63, 95%CI (-14.25,-1.01),P=0.02];舒芬太尼组插管后心指数较对照组高[MD=7.76,95%CI (6.45, 9.06),P<0.01];舒芬太尼组插管各期的舒张压、呼吸频率及氧饱和度与对照组相比,差异均无统计学意义(P>0.05)。结论舒芬太尼组较芬太尼组对插管后危重患者的循环系统抑制更低,血流动力学更稳定,更好地保护机械通气患者的心肺功能。
Objective To systematically evaluate effect of sufentanil versus fentanil on hemodynamics in critical patients with mechanical ventilation(MV). Methods The randomized controlled trials(RCTs) about sufentanil vs the date of their establishment. Fentanil for critical patients with MV was searched in PubMed, The Cochrane Library,CNKI, VIP and Wanfang Database from inception to April 25 th, 2018 and other relevant journals and references of the included literature were also searched manually. Two reviewers independently screened the studies according to the inclusion and exclusion criteria. Then, meta-analysis was performed using RevMan 5.3 software. The level of evidence was assessed by using Cochrane handbook. Results A total of eleven RCTs were included, of which there were 307 patients in sufentanil group while 302 patients in fentanil group. The results of meta-analysis showed that sufentanil group had lower systolic blood pressure(SBP) than fentanil group after MV(MD=-10.51, 95%CI-20.50 to-0.53, P=0.04), higher mean blood pressure(MBP) than Fentanil after MV(MD= 7.86, 95% CI 5.37 to 10.34, P<0.001), lower heart rate(HR)(MD=-7.63, 95%CI-14.25 to-1.01, P=0.02), Sufentanil groups had higher cardiac index(CI)(MD=7.76, 95%CI 6.45 to 9.06, P<0.01). There were no significant difference in diastolic blood pressure(DBP), respiratory rate(RR), SpO2 between the two groups during and after MV. Conclusion Current evidence shows that sufentail has less restraining impact on cardiovascular system, with more stable hemodynamics, which can better protect the cardio-pulmonary function.
作者
柳舟
董卫国
余追
张亮
姚兰
候果
谢文杰
LIU Zhou;DONG Wei-guo;YU Zhui;ZHANG Liang;YAO Lan;HOU Guo;XIE Wen-jie(Department of Intensive Care Unit,Wuhan 430060,Hubei,CHINA;Department of Gastroenterology,Wuhan 430060,Hubei,CHINA;Department of Radiology Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,CHINA)
出处
《海南医学》
CAS
2019年第1期115-120,共6页
Hainan Medical Journal
