| الوصف: |
Background Cardiac surgery patients are always companied with several kinds of tachyarrhythmias after admission to intensive care unit (ICU), which highly related to more mortality and morbidity. Dexmedetomidine (DEX) is the popular medicine used for sedation in ICU, whether or not have the antiarrhythmic effect need to be analyzed. Methods The three primary database, such as MEDLINE, Embase(OVID SP) and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched, all of the English language and randomized-control designed clinical publications comparing DEX to control medicines for sedation after elective cardiac surgery were included. Two independent colleagues conduct data extraction or other quality assessment. Subgroup analysis was carried out by different medicine used or whether or not Cardiopulmonary Bypass (CPB) applied. All of the tachyarrhythmias happened in atria and ventricles were analyzed. Results A total of 1295 patients in 9 studies met the selection criteria among 2587 studies that screened from the database. After quantitative synthesis, our results revealed that DEX group was associated with low incidence of Ventricular Arrhythmia (VA, OR 0.24,95% CI 0.09,0.64, I2=0%, P=0.005) compared to control group, and this outcome was graded moderate quality of evidence. Subgroup analysis also indicated that DEX VS propofol subgroup had obvious difference (OR 0.13,95% CI 0.03,0.56, I2=0%, P=0.007). No difference was found with low quality of evidence in DEX VS control group for Atrial Fibrillation (AF, OR 0.82,95% CI 0.60,1.10, I2=25%, P=0.19), the subgroup analysis got the consistent results, but the subgroup analysis by CPB showed high heterogeneity (VA, I2=59%, P=0.27), eventually the stability of the results was confirmed after sensitivity analysis (I2=19%, P=0.83). No obvious publication bias was found by Funnel plot. Conclusions This meta-analysis revealed with strong evidence that DEX has antiarrhythmic effect to decrease the incidence of VT and VF comparing to other control drugs following cardiac surgery. No difference was found with low quality of evidence in DEX VS control group for Atrial Fibrillation, but cautious interpretation should be noticed to the influence on AF, especially occurred under CPB. |
