右美托咪定对老年人全凭静脉麻醉食管切除术后谵妄的预防：一项双盲，随机临床试验

右美托咪定对老年人全凭静脉麻醉食管切除术后谵妄的预防：一项双盲，随机临床试验

贵州医科大学     麻醉与心脏电生理课题组

翻译：文春雷  编辑：张中伟  审核：曹莹

罂 粟 摘 要  

背景：已知右美托咪定是一种镇静剂。术后谵妄（POD）已被证实是大手术术后常见并发症，最近的研究表明，右美托咪定可以预防POD。然而，很少有右美托咪在食管切除术患者中的作用研究。

目的：探讨全凭静脉麻醉（TIVA）下右美托咪定在经胸食管切除术老年患者POD降低中的有效性和安全性。

设计：一项随机，双盲，安慰剂对照试验。地点：单中心，三级医院，2016年11月至2018年9月。

患者：符合条件的经胸食管切除术患者（n = 177），随机分为全凭静脉麻醉组（TIVA，n = 87）或右美托咪定与TIVA（DEX-TIVA，n = 90).

干预：接受DEX-TIVA的患者给予负荷剂量的右美托咪定（0.4μg /kg）持续15 min，之后以0.1 μg /min/h的速度输注，直到手术结束前1 h。接受TIVA的患者给予具有相同输注速度的生理盐水。

结果测量：主要结局是POD的发生率。次要结局是躁动的发生率，血清白细胞介素-6（IL-6）水平和血液动力学特征。

结果：所有随机患者均纳入POD意向治疗分析。90例给予右美托咪定的患者中有15例（16.7%）发生谵妄，87例给予生理盐水的患者中有32例（36.8%）发生谵妄（P = 0.0036). DEX-TIVA组的躁动率低于TIVA组（22.1 VS 48.0%，P = 0.0058). TIVA组手术引起的IL-6水平的增加量大于DEX-TIVA组（P < 0.0001).

结论：围手术期全凭静脉麻醉使用右美托咪定可减少经胸食管切除术老年患者的POD和术后躁动。这与术后促炎细胞因子IL-6水平的降低和血液动力学的稳定相关。

原始文献来源：Jun Hu, Mudan Zhu, Zongbin Gao, et al. A Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia A double-blind, randomised clinical trial.[J]. Eur J Anaesthesiol 2021; 38 (Suppl 1):S9–S17.

英文原文   

Dexmedetomidine for prevention of postoperative

delirium in older adults undergoing oesophagectomy

with total intravenous anaesthesia A double-blind, randomised clinical trial

Abstract

BACKGROUND：Dexmedetomidine is known to be a sedative. Recent studies suggest that administration of dexmedetomidine can prevent postoperative delirium (POD) which has been confirmed as a common complication after major surgery. However, its effects in patients undergoing oesophagectomy are scarce.

OBJECTIVE：To investigate the efficacy and safety of dexmedetomidine in reducing POD in elderly patients after transthoracic oesophagectomy with total intravenous anaesthesia (TIVA).

DESIGN A：randomised, double-blind, placebo-controlledtrial.

SETTING：Single-centre, tertiary care hospital, November 2016 to September 2018.

PATIENTS：Eligible patients (n=177) undergoing transthoracic oesophagectomy were randomly assigned to receive total intravenous anaesthesia (TIVA, n=87) or dexmedetomidine with TIVA (DEX-TIVA, n=90).

INTERVENTIONS：Patients receiving DEX-TIVA received a loading dose of dexmedetomidine (0.4ug/kg), over 15 min,followed by a continuous infusion at a rate of 0.1ug/kg/h until 1 h before the end of surgery. Patients receiving TIVA received physiological saline with a similar infusion rate protocol.

OUTCOME MEASURES：The primary outcome was the incidence of POD. The secondary endpoints were the incidence of emergence agitation, serum interleukin-6 (IL-6) levels and haemodynamic profile.

RESULTS：All randomised patients were included with planned intention-to-treat analyses for POD. Delirium occurred in 15 (16.7%) of 90 cases given dexmedetomidine,and in 32 (36.8%) of 87 cases given saline (P =0.0036).The DEX-TIVA group showed less frequent emergence agitation than the TIVA group (22.1 vs. 48.0%,P=0.0058). The incremental change in surgery-induced IL-6 levels was greater in the TIVA group than DEX-TIVA

group (P < 0.0001).

CONCLUSION：Adding peri-operative dexmedetomidine to a total intravenous anaesthetic safely reduces POD and emergence agitation in elderly patients undergoing open transthoracic oesophagectomy. These benefits were associated with a postoperative reduction in circulating levels of the proinflammatory cytokine IL-6 and stabilisation of the haemodynamic profile.

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