摘要
目的系统评价瑞马唑仑用于老年患者无痛胃镜镇静的效果与安全性,为临床镇静药物选择提供依据。方法系统检索PubMed、Scopus、Embase、Web of Science、Chinese Biomedical Literature Database、中国知网、万方数据知识服务平台等中英文数据库,检索时间截至2024年10月31日,采用meta分析对结局指标进行合并分析;采用漏斗图和Egger's检验评估发表偏倚。结果共纳入10篇文献,包含观察组1581例、对照组1580例,观察组镇静有效率略低于对照组(OR=0.63,95%CI:0.40~0.98,P=0.04);两组之间异致性低(I^(2)=0%);观察组镇静起效时间显著长于对照组(P<0.05),效应量(WMD=18.06,95%CI:11.34~24.78),P<0.05,异质性高度显著(I^(2)=98%);采用亚组分析异质性,分析结果不同中心情况选择是异质性的主要来源(I^(2)=98%,P>0.05);亚组间差异有统计学意义(P<0.05);合并结果显示观察组低血压、呼吸抑制、注射痛、体动、恶心呕吐等不良事件均低于对照组(P<0.05);镇静有效率的漏斗图显示,散点呈现明显对称分布,未发现部分散点在置信区间外,Egger's检验结果提示不存在潜在的发表偏倚(t=1.45,P=0.32)。结论瑞马唑仑在老年患者胃镜镇静中的安全性优于常用对照药物,可显著降低呼吸抑制、低血压、注射痛及体动等不良事件发生率,总体效果可靠、风险更低。
Objective To systematically evaluate the efficacy and safety of remimazolam for sedation in elderly patients undergoing painless gastroscopy,so as to provide evidence for clinical sedative drug selection.Methods A comprehensive search was conducted in both Chinese and English databases including PubMed,Scopus,Embase,Web of Science,Chinese Biomedical Literature Database,CNKI,and Wanfang Database up to October 31st 2024.Meta-analysis was performed to pool outcome measures.Publication bias was assessed using funnel plots and Egger's test.Results A total of 10 studies were included,comprising 1581 patients in the observation group and 1580 in the control group.The effective sedation rate was slightly lower in the observation group than in the control group(OR=0.63,95%CI:0.40-0.98,P=0.04),with low heterogeneity(I^(2)=0%).The sedation onset time was significantly longer in the observation group(WMD=18.06,95%CI:11.34-24.78,P<0.05),with high heterogeneity(I^(2)=98%).Subgroup analysis indicated that differences among centers were the main source of heterogeneity(I^(2)=98%,P>0.05),and inter-subgroup differences were statistically significant(P<0.05).Combined results showed that adverse events including hypotension,respiratory depression,injection pain,body movement,and nausea/vomiting were all lower in the observation group than in the control group(P<0.05).The funnel plot for effective sedation rate showed a symmetric scatter distribution without points outside the confidence interval.Egger's test suggested no significant publication bias(t=1.45,P=0.32).Conclusion Remimazolam demonstrates superior safety compared to commonly used control sedatives in elderly patients undergoing gastroscopy,significantly reducing adverse events such as hypotension,respiratory depression,injection pain,and body movement.It offers reliable efficacy with a lower risk profile.
作者
陈立新
蔡晓东
程松鹤
高民泰
涂泽华
CHEN Lixin;CAI Xiaodong;CHENG Songhe;GAO Mintai;TU Zehua(Department of Anesthesiology,Zhongshan Xiaolan People's Hospital(Shantou University Medical College Xiaolan Clinical College),Guangdong Zhongshan 528415,China)
出处
《临床药物治疗杂志》
2025年第9期45-52,共8页
Clinical Medication Journal
基金
中山市医学科研项目(2021A020347)。
