​右旋美托咪定对老年患者术后认知功能障碍的影响：一项基于随机对照试验的荟萃分析

右旋美托咪定对老年患者术后认知功能障碍的影响：一项基于随机对照试验的荟萃分析

贵州医科大学     麻醉与心脏电生理课题组

翻译：吴学艳  编辑：陈锐  审核：曹莹

罂 粟 摘 要   

背景:右美托咪定(Dex)被认为具有神经保护作用；然而，右美托咪定对老年患者术后认知功能障碍(POCD)的影响尚不清楚。

方法:采用随机对照试验(RCTs)进行荟萃分析，评估右美托咪定对POCD的影响；通过检索PubMed、Embase、Cochrane,s Library数据库获取相关研究；采用随机效应模型汇总结果。

结果:纳入14项随机对照试验，包括1626例60岁及以上接受全身麻醉手术的老年患者；由于POCD采用的量表存在差异，因此纳入了8项经简易智能精神状态检查量表(MMSE)诊断为POCD的 RCTs，6项经其他量表诊断为POCD的 RCTs进行定性综合；在经MMSE评估的RCTs结果显示，Dex显著降低POCD的发生率(相对危险度:0.47,95%置信区间:0.37-0.60,P＜0.001)，无显著异质性(I2=0%)或发表偏倚(Egger回归检验P=0.579)；采用其他量表诊断POCD的6项RCTs中，有3项研究显示右美托咪定显著降低POCD发生率，其他3项RCTs显示无显著差异。

结论:在采用MMSE诊断POCD的研究中获得右美托咪定能降低全麻手术老年患者发生POCD的风险；基于这些发现，右美托咪定可能是预防老年患者POCD的一种措施。

原始文献来源：

Yu H, Kang H, Fan J, et al. Influence of dexmedetomidine on postoperative cognitive dysfunction in the elderly: A meta-analysis of randomized controlled trials[J]. Brain Behav. 2022 Jul 10:e2665. DOI: 10.1002/brb3.2665.

英文原文

Influence of dexmedetomidine on postoperative cognitive

dysfunction in the elderly: A meta-analysis of randomized

controlled trials

Abstract

Introduction: Dexmedetomidine (Dex) is suggested to be neuroprotective. However, influence of Dex on postoperative cognitive dysfunction (POCD) in the elderly remains unknown.

Methods: We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of Dex on POCD. Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results.

Results: Fourteen RCTs including 1626 adults of 60 years or older who received surgery with general anesthesia were included. Because methodologically diverse scales were used for POCD, eight RCTs with POCD diagnosed with Mini-Mental State Examination (MMSE) were included in the meta-analysis, while the remaining six RCTs with POCD diagnosed with other scales were qualitative synthesized. Pooled results of RCTs with MMSE showed that Dex significantly reduced the incidence of POCD (risk ratio: 0.47, 95% confidence interval: 0.37-0.60, p < 0.001) with no significant heterogeneity (I2 = 0%) or publication bias (p for Egger's regression test = 0.579). For the remaining six RCTs with POCD diagnosed with other scales, three of them showed that Dex was associated with a significantly lower incidence of POCD, while the other three RCTs did not show a significant difference.

Conclusions: Dex is associated with a reduced risk of POCD in elderly patients receiving surgeries with general anesthesia, and the results were mainly obtained in studies with POCD diagnosed with MMSE. Based on these findings, Dex may be considered as a preventative measure for POCD in elderly patients.