【罂粟摘要】脑肿瘤切除术中应用右美托咪定预防术后谵妄：一项随机试验

脑肿瘤切除术中应用右美托咪定预防术后谵妄：一项随机试验  

贵州医科大学  麻醉与心脏电生理课题组

翻译:佟睿    编辑：马艳燕   审校：曹莹

背景：谵妄是临床常见的疾病之一，尤其是发生在神经外科手术后。右美托咪定可能通过改善术后镇痛和睡眠质量等方面来减少谵妄的发生。我们验证了最初的假设，即在脑内肿瘤切除术中使用右美托咪定可降低术后谵妄的发生率。

方法：这项随机、双盲、安慰剂对照试验在北京的两家三级医院进行。我们将260名符合条件的患者随机分为右美托咪定组（n=130）或安慰剂组（n=130）。被分配到右美托咪定组的受试者给予0.6 μg·kg-1的负荷剂量，然后以0.4 μg·kg-1·h-1的速度持续输注，直到关闭硬膜；安慰剂组的受试者给予同等体积的生理盐水。主要观察指标是谵妄的发生率，即在术后前5天内，每天用混乱评估法评估两次。

结果：参与患者的年龄均数（标准差）为45（12）岁，手术时间为4.2（1.5）小时，被分配到右美托咪定组的患者平均获得126（45）μg的右美托咪定。被分配到右美托咪定组的患者（22%，28/130名）在术后最初5天的谵妄比给予安慰剂的患者（46%，60/130名）少，风险比为0.51（95%置信区间：0.36-0.74，P<0.001）。术后疼痛评分、运动、恢复和睡眠质量都因右美托咪定而得到改善（P<0.001）。各组的安全性结果相似。

结论：预防性术中输注右美托咪定使择期脑肿瘤切除术后前5天的谵妄发生率减少一半。

原始文献来源：Shu Li, Ruowen Li, Muhan Li, et al. Dexmedetomidine administration during brain tumour resection for prevention of postoperative delirium: a randomised trial.[J]Br J Anae, doi: 10.1016/j.bja.2022.10.041.

英文原文：

Dexmedetomidine administration during brain tumour resection for prevention of postoperative delirium: a randomised trial

Background: Delirium is common, especially after neurosurgery. Dexmedetomidine might reduce delirium by improving postoperative analgesia and sleep quality. We tested the primary hypothesis that dexmedetomidine administration during intracerebral tumour resection reduces the incidence of postoperative delirium.

Method: This randomised, double-blind, placebo-controlled trial was conducted in two tertiary-care hospitals in Beijing. We randomised 260 qualifying patients to either dexmedetomidine (n=130) or placebo (n=130). Subjects assigned to dexmedetomidine were given a loading dose of 0.6 μg kg-1 followed by continuous infusion at 0.4 μg kg-1 h-1 until dural closure; subjects in the placebo group were given comparable volumes of normal saline. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method twice daily during the initial 5 postoperative days.

Results: The average (standard deviation) age of participating patients was 45 (12) yr, duration of surgery was 4.2 (1.5) h, and patients assigned to dexmedetomidine were given an average of 126 (45) μg of dexmedetomidine. There was less delirium during the initial 5 postoperative days in patients assigned to dexmedetomidine (22%, 28 of 130 patients) than in those given placebo (46%, 60 of 130 patients) with a risk ratio of 0.51 (95% confidence interval: 0.36-0.74, P<0.001). Postoperative pain scores with movement, and recovery and sleep quality were improved by dexmedetomidine (P<0.001). The incidence of safety outcomes was similar in each group.

Conclusion: Prophylactic intraoperative dexmedetomidine infusion reduced by half the incidence of delirium during the initial 5 postoperative days in patients recovering from elective brain tumour resection.

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