右美托咪定与拉贝他洛尔对喉镜和气管插管后血流动力学应激反应的比较作用：随机对照试验的系统回顾和荟萃分析

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care Pub Date : 2025-08-20 DOI:10.1016/j.tacc.2025.101588

Milton Morais Correia Neto , Mauricio Cardoso Paz , Ana Carolina Oliveira Crisóstomo , Isabella Soares Marques Rabelo , Beatriz Guimarães Amorim Luna , Priscila Ferreira de Lima e Souza

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引用次数: 0

摘要

背景：喉镜检查和气管插管引起交感神经激增，导致心率、收缩压、舒张压和平均动脉压的短暂升高，潜在地增加围手术期心血管风险。右美托咪定和拉贝他洛尔都用于减轻这种反应，但它们的相对疗效尚不清楚。本研究旨在综合目前的证据，比较它们对围插管期血流动力学反应的影响。方法：我们按照PRISMA 2020指南进行了系统评价和荟萃分析。检索PubMed、Embase、Scopus、Web of Science、Cochrane和谷歌Scholar，比较右美托咪定和拉贝他洛尔的随机对照试验。主要结局是心率和收缩压；次要结局包括舒张压和平均动脉压。数据分析采用随机效应模型。使用RoB 2工具评估偏倚风险，使用GRADE框架评估证据的确定性。结果纳入8项随机试验，共514例患者。与拉贝他洛尔相比，右美托咪定在插管后3、5和10分钟显著降低收缩压（平均差值为- 7.46至- 8.62 mmHg）；1 min时（−3.96 mmHg）差异无统计学意义。心率在所有时间点均显著降低（平均差值为- 10.59至- 14.05 bpm）。舒张压和平均动脉压的降低也一致且具有统计学意义。不良事件很少报道。两项研究记录了心动过缓和低血压，其中一项研究右美托咪定组和另一项研究拉贝他洛尔组的发生率略高。其余的研究没有报告不良事件，尽管定义差异很大。结论与拉贝他洛尔相比，右美托咪定对插管血流动力学反应的衰减更大。然而，证据的确定性从低到中等，安全性数据有限。需要进一步的高质量试验来完善给药策略并评估在更广泛患者群体中的适用性。试验注册本荟萃分析的方案已在PROSPERO注册（CRD420251007007）。

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Comparative effects of dexmedetomidine versus labetalol on hemodynamic stress response to laryngoscopy and tracheal intubation: A systematic review and meta-analysis of randomized controlled trials

Background

Laryngoscopy and tracheal intubation provoke a sympathetic surge, leading to transient elevations in heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure, potentially increasing perioperative cardiovascular risk. Dexmedetomidine and labetalol are both used to attenuate this response, but their comparative efficacy remains unclear. This study aimed to synthesize current evidence comparing their effects on peri-intubation hemodynamic responses.

Methods

We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Embase, Scopus, Web of Science, Cochrane, and Google Scholar were searched for randomized controlled trials comparing dexmedetomidine with labetalol. Primary outcomes were heart rate and systolic blood pressure; secondary outcomes included diastolic blood pressure and mean arterial pressure. Data were analyzed using random-effects models. Risk of bias was assessed using the RoB 2 tool, and certainty of evidence was evaluated with the GRADE framework.

Results

Eight randomized trials involving 514 patients were included. Dexmedetomidine significantly reduced systolic blood pressure at 3, 5, and 10 min post-intubation (mean difference −7.46 to −8.62 mmHg) compared to labetalol; the difference at 1 min (−3.96 mmHg) was not statistically significant. Heart rate was significantly reduced at all timepoints (mean difference −10.59 to −14.05 bpm). Reductions in diastolic blood pressure and mean arterial pressure were also consistent and statistically significant. Adverse events were infrequently reported. Two studies documented bradycardia and hypotension, with slightly higher rates in the dexmedetomidine group in one study and in the labetalol group in another. The remaining studies reported no adverse events, though definitions varied substantially.

Conclusions

Dexmedetomidine was associated with greater attenuation of the hemodynamic response to intubation compared to labetalol. However, the certainty of evidence ranged from low to moderate and safety data were limited. Further high-quality trials are warranted to refine dosing strategies and assess applicability in broader patient populations.