术中右美托咪定对癌症手术患者预后的影响：系统综述与荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
癌症给患者和医疗系统带来了巨大的负担。右美托咪定（DEX）是一种常用于麻醉的α2肾上腺素能受体激动剂，对癌症生物学具有潜在影响。本研究通过系统综述和荟萃分析，评估术中DEX对癌症患者术后生存和肿瘤复发的影响。
方法
检索PubMed、Web of Science、Embase和中国知网（截至2024年4月）。两名研究人员提取了包括作者、年份、国家、研究设计、随访时间、患者特征以及总生存率（OS）和无复发生存率（RFS）的风险比（HR）及其95%置信区间（CI）等数据。采用Cochrane随机对照试验工具评估RCT偏倚风险，并使用Newcastle-Ottawa量表对回顾性研究进行质量评估。
结果
本次综述共纳入12项研究，其中包含6项随机对照试验（RCT）和6项回顾性研究。随机对照试验数据显示，术中使用右美托咪定对患者OS未见显著影响（OR 0.87, 95% CI 0.67–1.13, P=0.29），但能有效提升RFS(OR 0.65, 95% CI 0.47–0.91, P=0.01）。而回顾性研究表明，该药物会降低患者OS（匹配后HR 1.52, 95% CI 1.15–2.00, P=0.003），但对RFS无显著影响（匹配后HR 1.29, 95% CI 0.96–1.72, P=0.09）。
关于术中使用右美托咪定对术后癌症预后的影响，RCTs与回顾性研究结果存在矛盾：前者支持DEX改善无复发生存率（RFS），后者提示其可能降低总生存率（OS）。现有证据有限且异质性高，需更多高质量RCT明确DEX对癌症预后的影响。
原始文献：Zhang C, Qu Y, Cao Q, et. Effect of intraoperative dexmedetomidine on prognosis in patients with cancer undergoing surgical procedures: a systematic review and meta-analysis. Br J Anaesth. 2025 Jul;135(1):89-98. doi: 10.1016/j.bja.2025.02.041. Epub 2025 Apr 30. PMID: 40312167.
Effect of intraoperative dexmedetomidine on prognosis in patients with cancer undergoing surgical procedures: a systematic review and meta-analysis
ABSTRACT
Background: Cancer places a significant burden on patients and healthcare systems. Dexmedetomidine, an α2 adrenergic agonist commonly used in anaesthesia, has potential effects on cancer biology. We systematically reviewed and analysed the impact of intraoperative dexmedetomidine on postoperative survival and tumour recurrence in patients with cancer.
Methods: We conducted a comprehensive search of PubMed, Web of Science, Embase, and the China National Knowledge Infrastructure up to April 2024. Two researchers extracted data including authors, year, country, study design, follow-up, patient characteristics, and hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival and recurrence-free survival. Quality assessment was conducted using the Cochrane tool for randomised controlled trials (RCTs) and the Newcastle-Ottawa Scale for retrospective studies.
Results: The review identified 12 studies: six RCTs and six retrospective studies. In the RCTs, intraoperative dexmedetomidine showed no significant effect on overall survival (odds ratio [OR] 0.87, 95% CI 0.67-1.13, P=0.29) but improved recurrence-free survival (OR 0.65, 95% CI 0.47-0.91, P=0.01). Retrospective studies indicated that dexmedetomidine was associated with decreased overall survival (post-matching HR 1.52, 95% CI 1.15-2.00, P=0.003), and had no significant effect on recurrence-free survival (post-matching HR 1.29, 95% CI 0.96-1.72, P=0.09).
Conclusions: Meta-analysis reveals inconsistent evidence regarding impact of intraoperative dexmedetomidine on cancer outcomes after surgery. RCTs suggest improved recurrence-free survival, whereas retrospective studies suggest potential reductions in overall survival. The limited and contradictory data highlight the necessity for more high-quality RCTs to clarify the effects of dexmedetomidine on survival and prognosis in this population.