• 1 四川大學(xué)華西醫(yī)院麻醉科（成都，610041）;2 天津中心婦產(chǎn)醫(yī)院麻醉科;

【摘要】　目的　 評(píng)價(jià)α2受體激動(dòng)劑是否可以降低七氟烷引起的小兒術(shù)后躁動(dòng)的發(fā)生率。　方法　 通過(guò)檢索Medline、荷蘭醫(yī)學(xué)文摘、Cochrane臨床試驗(yàn)數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)和中國(guó)期刊網(wǎng)全文數(shù)據(jù)庫(kù)等數(shù)據(jù)庫(kù)，收集可樂(lè)定或右美托咪啶對(duì)七氟烷引起的小兒術(shù)后躁動(dòng)的預(yù)防作用的隨機(jī)對(duì)照試驗(yàn)（randomized controlled trial，RCT），提取資料和評(píng)估方法學(xué)質(zhì)量，采用Cochrane協(xié)作網(wǎng)RevMan 5.0軟件進(jìn)行Meta分析。　結(jié)果　 最終納入11個(gè)RCT，其中104例患兒預(yù)防性使用右美托咪啶，268例患兒使用可樂(lè)定，365例患兒使用安慰劑。Meta分析顯示，可樂(lè)定組小兒術(shù)后躁動(dòng)發(fā)生率的比值比（OR）為0.31，95%CI為（0.15，0.61）（P=0.000 8）；右美托咪啶組小兒術(shù)后躁動(dòng)發(fā)生率的OR為0.16，95%CI為（0.08，0.31）（P lt;0.000 01）。　結(jié)論　 α2受體激動(dòng)劑可以顯著降低七氟烷引起的小兒術(shù)后躁動(dòng)的發(fā)生率。
【Abstract】　Objective　 To determine whether alpha2-adrenoceptor agonists can decrease emergence agitation (EA) in pediatric patients after sevoflurane anesthesia.　Methods　 The Medline, Embase, Cochrane Library, CBM and CNKI were searched. All randomized controlled trials comparing clonidine or dexmedetomidine with other interventions in preventing emergence agitation after sevoflurane anesthesia were retrieved. Study selection and assessment, data collection and analyses were undertaken. Meta-analysis was done using the Cochrane Collaboration RevMan 5.0 software.　Results　 Eleven articles reached our inclusion criteria and were included in the Meta-analysis. A total of 104 children treated with dexmedetomidine, 268 children treated with clonidine, and 365 children treated with placebo were evaluated for the incidence of emergence agitation. The pooled odds ratio for the clonidine subgroup was 0.31, with a 95% confidence interval of 0.15-0.61 (P=0.000 8). The pooled odds ratio for the dexmedetomidine subgroup was 0.16, with a 95% confidence interval of 0.08-0.31 (P lt;0.000 01).　Conclusion　 Alpha2-adrenoceptor agonists can significantly decrease the incidence of emergence agitation in pediatric patients after sevoflurane anesthesia.

引用本文： 李燁,張艷菊,余海,王儒蓉. α2受體激動(dòng)劑預(yù)防七氟烷引起小兒術(shù)后躁動(dòng)的Meta分析. 華西醫(yī)學(xué), 2011, 26(12): 1859-1863. doi: 復(fù)制

1. 　Aono J, Ueda W, Mamiya K, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys[J]. Anesthesiology, 1997, 87(6): 1298-1300.
2. 　Kuratani N, Yumiko Oi. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane[J]. Anesthesiology, 2008, 109(2): 225-232.
3. 　Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children[J]. Anesth Analg, 2001, 93(2): 335-338.
4. 　Bock M, Kunz P, Schreckenberger R, et al. Comparison of caudal and intravenous clonidine in the prevention of agitation after sevoflurane in children[J]. Br J Anaesth, 2002, 88(6): 790-796.
5. 　Sipiläinen U, Avela R, Tarkkila P, et al. Prophylaxis of emergence agitation after sevoflurane anaesthesia in children undergoing outpatient adenoidectomy[J]. Finnanest, 2003, 36(5): 491.
6. 　Tesoro S, Mezzetti D, Marchesini L, et al. Clonidine treatment for agitation in children after sevoflurane anesthesia[J]. Anesth Analg, 2005, 101(16): 1619-1622.
7. 　Malviya S, Terri Voepel-Lewis, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile[J]. Pediatr Anesth, 2006, 16(5): 554-559.
8. 　Lankinen U, Avela R, Tarkkila P, et al. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy[J]. Anesth Analg, 2006, 102(5): 1383-1386.
9. 　Tazeroualti N, De Groote F, De Hert S, et al. Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial[J]. Br J Anaesth, 2007, 98(5): 667-671.
10. 　Ibacache ME, Muoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in childred[J]. Anesth Analg, 2004, 98(1): 60-63.
11. 　Guler G, Akīn A, Tosun Z, et al. Single dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy[J]. Pediatr Anesth, 2005, 15(9): 762-766.
12. 　Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia?[J]. Pediatr Anesth, 2005, 15(12): 1098-1104.
13. 　Isik B, Arslan M, Dogan, A et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery[J]. Pediatr Anesth, 2006, 16(7): 748-753.
14. 　Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit[J]. Anesth Analg, 2003, 96(6): 1625-1630.
15. 　Goa KL, Noble S, Spencer CM. Sevoflurane in paediatric anaesthesia: a review[J]. Paediatr Drugs, 1999, 1(2): 127-153.
16. 　Maze M, Tranquilli W. Alpha2-adrenergic agonists: defining the role in clinical anesthesia[J]. Anesthesiology, 1991, 74(3): 581-605.
  1. 1. 　Aono J, Ueda W, Mamiya K, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys[J]. Anesthesiology, 1997, 87(6): 1298-1300.
  2. 2. 　Kuratani N, Yumiko Oi. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane[J]. Anesthesiology, 2008, 109(2): 225-232.
  3. 3. 　Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children[J]. Anesth Analg, 2001, 93(2): 335-338.
  4. 4. 　Bock M, Kunz P, Schreckenberger R, et al. Comparison of caudal and intravenous clonidine in the prevention of agitation after sevoflurane in children[J]. Br J Anaesth, 2002, 88(6): 790-796.
  5. 5. 　Sipiläinen U, Avela R, Tarkkila P, et al. Prophylaxis of emergence agitation after sevoflurane anaesthesia in children undergoing outpatient adenoidectomy[J]. Finnanest, 2003, 36(5): 491.
  6. 6. 　Tesoro S, Mezzetti D, Marchesini L, et al. Clonidine treatment for agitation in children after sevoflurane anesthesia[J]. Anesth Analg, 2005, 101(16): 1619-1622.
  7. 7. 　Malviya S, Terri Voepel-Lewis, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile[J]. Pediatr Anesth, 2006, 16(5): 554-559.
  8. 8. 　Lankinen U, Avela R, Tarkkila P, et al. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy[J]. Anesth Analg, 2006, 102(5): 1383-1386.
  9. 9. 　Tazeroualti N, De Groote F, De Hert S, et al. Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial[J]. Br J Anaesth, 2007, 98(5): 667-671.
  10. 10. 　Ibacache ME, Muoz HR, Brandes V, et al. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in childred[J]. Anesth Analg, 2004, 98(1): 60-63.
  11. 11. 　Guler G, Akīn A, Tosun Z, et al. Single dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy[J]. Pediatr Anesth, 2005, 15(9): 762-766.
  12. 12. 　Shukry M, Clyde MC, Kalarickal PL, et al. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia?[J]. Pediatr Anesth, 2005, 15(12): 1098-1104.
  13. 13. 　Isik B, Arslan M, Dogan, A et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery[J]. Pediatr Anesth, 2006, 16(7): 748-753.
  14. 14. 　Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit[J]. Anesth Analg, 2003, 96(6): 1625-1630.
  15. 15. 　Goa KL, Noble S, Spencer CM. Sevoflurane in paediatric anaesthesia: a review[J]. Paediatr Drugs, 1999, 1(2): 127-153.
  16. 16. 　Maze M, Tranquilli W. Alpha2-adrenergic agonists: defining the role in clinical anesthesia[J]. Anesthesiology, 1991, 74(3): 581-605.