肾上腺素能拮抗剂在气管拔管患者中的呼吸结局：随机对照试验的系统回顾和荟萃分析。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology Pub Date : 2025-07-05 DOI:10.1016/j.bjane.2025.844659

Lucas Cael Azevedo Ramos Bendaham , Altair Pereira de Melo Neto , Hilária Saugo Faria , André Richard da Silva Oliveira Filho , Carlos Henrique de Oliveira Ferreira , Marcela da Silva Kazitani Cunha , Victor Gonçalves Soares , Ocílio Ribeiro Gonçalves , Milene Vitória Sampaio Sobral , Mohamed Doma , Denis Maltz Grutcki , Fabrício Tavares Mendonça

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引用次数: 0

摘要

背景：全麻后气管拔管可能引起血流动力学和呼吸系统并发症，目前尚无既定的预防策略。我们进行了一项荟萃分析，以评估-受体阻滞剂在气管拔管患者中的安全性和有效性。方法：我们检索了MEDLINE、EMBASE和CENTRAL数据库中截至2024年的随机对照试验，比较β受体阻滞剂和安慰剂在气管拔管患者中的应用。主要结局：咳嗽强度；继发：支气管痉挛、屈曲、高血压。计算风险比（RR）和95%置信区间（95% CI）。对异质性高的结果进行留一敏感性和meta回归分析。结果：我们纳入了31项随机研究，包括1803例患者，其中965例接受β受体阻滞剂治疗。中/重度咳嗽风险(RR = 0.21；95% CI 0.13 ~ 0.34；P < 0.001；I2 = 0%)和高血压(RR = 0.28；95% CI 0.13 ~ 0.58；P < 0.001；I2 = 45%)明显低于安慰剂组。两组间发生支气管痉挛的风险比较，差异无统计学意义(RR = 0.58；95% CI 0.17 ~ 1.94；p = 0.375;I2 = 0%)或屈曲(RR = 0.47；95% CI 0.20 ~ 1.13；p = 0.093;I2 = 72%)。敏感性分析发现mendon(2023)是屈曲的主要异质性来源。结论：我们的研究表明，与安慰剂相比，受体阻滞剂可以减少气管拔管患者的中度/重度咳嗽和高血压，但在支气管痉挛和屈曲的风险方面没有显著差异。这些发现表明-受体阻滞剂可能是预防拔管周围血流动力学不稳定和气道高反应性的一种有价值的策略。

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Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials

Background

Tracheal extubation after general anesthesia may cause hemodynamic and respiratory complications, with no established strategies to prevent them. We conducted a meta-analysis to evaluate the safety and efficacy of beta-blockers in patients undergoing tracheal extubation.

Methods

We searched the MEDLINE, EMBASE and CENTRAL databases for randomized controlled trials up to 2024 comparing beta-blockers to placebo in patients undergoing tracheal extubation. Primary outcome: cough intensity; secondary: bronchospasm, bucking, hypertension. Risk Ratios (RR) with 95% Confidence Intervals (95% CI) were computed. Leave-one-out sensitivity and meta-regression analyses were performed for outcomes with high heterogeneity.

Results

We included 31 randomized studies, comprising 1,803 patients, of whom 965 received beta-blockers. The risk of moderate/severe cough (RR = 0.21; 95% CI 0.13 to 0.34; p < 0.001; I² = 0%) and hypertension (RR = 0.28; 95% CI 0.13 to 0.58; p < 0.001; I² = 45%) was significantly lower in the beta-blockers group compared with the placebo group. There were no statistically significant differences between groups in the risk of bronchospasm (RR = 0.58; 95% CI 0.17 to 1.94; p = 0.375; I² = 0%) or bucking (RR = 0.47; 95% CI 0.20 to 1.13; p = 0.093; I² = 72%). Sensitivity analysis identified Mendonça (2023) as the main heterogeneity source in bucking.

Conclusion

Our study demonstrates that beta-blockers reduced moderate/severe cough and hypertension in patients undergoing tracheal extubation compared with placebo with no significant difference in the risk of bronchospasm and bucking. These findings suggest beta-blockers may be a valuable strategy for preventing peri-extubation hemodynamic instability and airway hyperresponsiveness.