Objective To evaluate the effects of dexmedetomidine on hemodynamics and stress reaction in pediatric patients undergoing cardiac surgery.Methods Randomized controlled trials (RCTs) on the effects of dexmedetomidine on hemodynamics and stress response in pediatric cardiac surgery were searched from PubMed,CENTRAL,EMbase,the ISI Web of Knowledge Databases,VIP,CNKI,CBM and Wanfang database,and the retrieval time limit was from the date of establishment to 2016 October.The references of those RCTs were also searched by hand.According to the inclusion and exclusion criteria,the RCTs were screened and extracted by two reviewers independently,and Meta analysis was performed using RevMan 5.2 software.The intraoperative heart rates(HR),mean arterial pressure(MAP),serum cortisol(Cort) concentration,glucose(Glu),epinephrine (E),and norepinephrine (NE) between dexmedetomidine group and physiological saline group were compared.The results were expressed as mean (WMD),normalized mean (SMD),95％ confidence interval(CI).Results Eight studies involving 323 patients were included.In the aspect of hemodynamics,the heart rate and mean arterial pressure in dexmedetomidine group were significantly lower than those in saline group at 10 min after delivery,after the skin incision or after thoracotomy,and the difference was statistically significant.At 10 min after delivery,the WMD was-23.06 for heart rate [95％ CI (-35.32,-10.79),P =0.000 2] and-13.76 for mean arterial pressure [95 ％ CI (-18.34,-9.19),P ＜ 0.000 01].After the skin incision,the WMD was-32.84 for heart rate [95 ％ CI (-39.43,-26.26),P ＜ 0.000 01] and-16.13 for mean arterial pressure [95 ％ CI (-20.65,-11.60),P ＜ 0.000 01].After thoracotomy,the WMD was-14.88 for heart rate [95 ％ CI (-20.02,-9.73),P =0.000 9] and-14.51 for mean arterial pressure [95 ％ CI (-19.17,-9.84),P ＜ 0.000 01].In the aspect of stress reaaction,the concentration of serum cortisol,blood glucose,epinephrine and norepinephrine decreased after drug intervention,and the difference was statistically significant.The WMD was-269.01 for serum cortisol [95％ CI (-457.71,-80.31),P ＜ 0.000 01],-1.81 for blood glucose [95％ CI (-2.43,-1.19),P ＜ 0.000 01],-26.23 for epinephrine [95％ CI (-56.39,-3.92),P ＜ 0.00001],and-49.44 for norepinephrine[95％ CI(-56.18,-42.70),P＜0.00001].Conclusion Dexmedetomidine can reduce heart rate,mean arterial pressure and stress response in pediatric cardiac surgery.%目的 评价右美托咪定对小儿心脏手术血流动力学及应激反应的影响. 方法 计算机检索PubMed、CENTRAL、EMbase、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有有关右美托咪定对小儿心脏手术血流动力学及应激反应影响的随机对照试验(RCT),检索时限均为建库至2016年10月,同时手检纳入文献的参考文献.按照纳入排除标准由两人独立进行RCT的筛选和资料提取,采用RevMan 5.2软件进行Meta分析.比较右美托咪定组和生理盐水组小儿术中心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、血浆皮质醇(plasma cortisol,Cort)浓度、血糖(glucose,Glu)、肾上腺素(adrenaline,E)、去甲肾上腺素(norepinephrine,NE)的差异,结果以加权均数(WMD),标准化均数差(SMD),95％的置信区间(CI)表示. 结果 共纳入8个研究,323个小儿患者.Meta分析显示:右美托咪定组的心率和平均动脉压在给药10 min后、切皮后、开胸后均低于生理盐水组,差异有统计学意义[给药10 min后,心率WMD=-23.06,95％CI(-35.32,-10.79),P=0.000 2;平均动脉压WMD=-13.76,95％ CI(-18.34,-9.19),P＜0.000 01;切皮后,心率WMD=-32.84,95％ CI(-39.43,-26.26),P＜0.00001;平均动脉压WMD=-16.13,95％ CI(-20.65,-11.60),P＜0.000 01;开胸后,心率WMD=-14.88,95％ CI(-20.02,-9.73),P=0.000 9;平均动脉压WMD=-14.51,95％ CI(-19.17,-9.84),P＜0.00001].药物干预后,患儿的血浆皮质醇、血糖、肾上腺素、去甲肾上腺素浓度降低,差异有统计学意义[血浆皮质醇WMD =-269.01,95％ CI(-457.71,-80.31),P＜0.00001;血糖WMD=-1.81,95％ CI(-2.43,-1.19),P＜0.00001;肾上腺素WMD=-26.23,95％ CI(-56.39,-3.92),P＜0.00001;去甲肾上腺素WMD=-49.44,95％ CI(-56.18,-42.70),P＜0.000 01]. 结论 右美托咪定可降低小儿心脏手术中的心率、平均动脉压和应激反应.
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