| Objectives To systematically evaluate the cerebral protective effect of dexmedetomidine in the cardiac valve replacement under extracorporeal circulation by meta-analysis.Methods Two researchers independently retrieved the Pub Med,Embase,Cochrane Library,CBM,Ovid,CNKI,Wanfang,Weipu and other databases and Google scholar,Baidu scholar academic search engine,and so on,looked up the research literatures about the cerebral protection of dexmedetomidine in the cardiac valve replacement under extracorporeal circulation had reported in the journal.The retrieval time limit was from inception to March 2017,and the language includes Chinese and English.At the same time,traced back the references which were included,and combined with manual access to relevant professional journals,as far as possible to avoid the literatures missing.The results were selected and excluded by the two investigators according to the inclusion and exclusion criteria,the literatures were selected after the final cross-check,if there had divarica-tion,then resolved them through discussion.The modified Jadad scale was used to evaluate the quality of the literatures,and the information and datum were extracted,the observation indexes were as follows:(1)the cerebral oxygen metabolism indexes including perioperative jugular bulb oxygen saturation(Sjv O2)and arterial jugular bulb oxygen content difference(Ca-jv O2/Da-jv O2)and cerebral extraction of oxygen(CERO2);(2)blood S-100? protein;(3)blood neuron-specific enolase(NSE)in patients undergoing cardiac valve replacement surgery.Finally,based on the different observation time and observation indexes,the meta-analysis was carried out to the eligible literatures by Rev Man5.2 software.Results Finally,through the retrieval and screening,seven literatures were selected,which were randomized controlled trial(RCT),a total of 416 patients(experimental group and control group,each group of 208 patients),both score of modified Jadad scale were 3,and the results of meta-analys is were as follows.(1)Compared with the control group,dexmedetomidine could improve Sjv O2 at opening the ascending aorta,extracorporeal circulation ending,10 min after extracorporeal circulation ending[SMD=1.25,95%CI(0.99,1.52),P<0.05;SMD=1.18,95%CI(0.89,1.48),P<0.05;SMD=0.88,95%CI(0.50,1.27),P<0.05].Dexmedetomidine could reduce Da-jv O2/Ca-jv O2 at opening the ascending aorta,extracorporeal circulation ending,10 min after extracorporeal circulation ending [SMD=-1.2,95%CI(-1.47,-0.94),P<0.05;SMD=-0.83,95%CI(-1.12,-0.55),P<0.05;SMD=-1.02,95%CI(-1.41,-0.63),P<0.05].At the observation time of operation ending,the results of the studies were significantly different,so only a general statistical description was taken.Dexmedetomidine could reduce CERO2 at opening the ascending aorta,extracorporeal circulation ending,10 min after extracorporeal circulation en-ding and operation ending [SMD=-0.97,95%CI(-1.23,-0.71),P<0.05;SMD=-0.95,95%CI(-1.52,-0.39),P<0.05;SMD=-0.51,95%CI(-0.88,-0.14),P<0.05;SMD=-0.73,95%CI(-1.23,-0.23),P<0.05].Dexmedetomidine had no effect on Sjv O2 of operation ending and 6h after operation,Da-jv O2/Ca-jv O2 and CERO2 of 6h after operation[SMD=0.44,95%CI(-0.06,0.94),P>0.05;SMD=-0.17,95%CI(-0.45,0.11),P>0.05;SMD=-0.09,95%CI(-0.37,0.19),P>0.05;SMD=-0.1,95%C I(-0.38,0.18),P>0.05].(2)Compared with the control group,dexmedetomidine could reduce the blood concentration of S-100? protein at opening the ascending aorta,extracorporeal circulation ending,10 min after extracorporeal circulation ending,6h after operation,24 h after operation [SMD=-0.26,95%CI(-0.50,-0.02),P<0.05;SMD=-0.63,95%CI(-0.91,-0.35),P<0.05;SMD=-0.64,95%CI(-1.19,-0.09),P<0.05;SMD=-0.37,95%CI(-0.65,-0.09),P<0.05;SMD=-0.30,95%CI(-0.58,-0.02),P<0.05].At the observation time of operation ending,the results of the studies were significantly different,so only a general statistical description was taken;(3)Compared with the control group,dexmedetomidine could reduce the blood concentration of NSE at opening the ascending aorta,extracorporeal circulation ending,10 min after extracorporeal circulation ending,operation ending,6h after operation [SMD=-0.61,95%CI(-0.86,-0.37),P<0.05;SMD=-0.56,95%CI(-0.84,-0.29),P<0.05;SMD=-0.9,95%CI(-1.29,-0.52),P<0.05;SMD=-0.79,95%CI(-1.07,-0.51),P<0.05;SMD=-0.68,95%CI(-0.97,-0.39),P<0.05].Dexmedetomidine had no effect on the blood concentration of NSE at 24 h after operation[SMD=-0.21,95%CI(-0.53,0.11),P>0.05]Sensitivity analysis was performed by successive elimination of single study and replacement of statistical models,the effect of dexmedetomidine on perioperative blood concentration of NSE by meta-analysis w-as robust,while the effects on the cerebral oxygen metabolism indexes and blood concentration of S-100? protein were not stable.The meta-analysis results of following observations were changed after ensitivity analysis:(1)cerebral oxygen metabolism indexes: the Sjv O2 at operation ending,the CERO2 at extracorporeal circulation ending and operation ending;(2)the blood concentration of S-100? protein at opening the ascending aorta,10 min after extracorporeal circulation ending,6h after operation,24 h after operation.Conclusions Based on the meta-analysis of the RCT literatures,the following conclusions were drawn:(1)Dexmedetomidine could reduce blood concentration of NSE at intraoperative and postoperative early stage in the cardiac valve replacement surgery under extra corporeal circulation,the results of meta-analysis were robust,which suggested that dexmedetomidine had a good cerebral protective effect in the cardiac valve replacement sur gery under extracorporeal circulation.(2)As meta-analysis results were not stable of the effects of dexmedetomidine on perioperative cerebral oxygen metabolism indexes and blood S-100? protein,at the same time,the number of eligible literatures were small and the quality was low,the related conclusions needed to be further demonstrated by more high-quality RCT. |
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