术后谵妄：右美托咪定组优于丙泊酚？

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

在脊麻下接受骨科下肢手术的健康老年人中，右美托咪定与丙泊酚镇静后的术后谵妄：一项随机对照试验

背景：

谵妄是老年患者术后的重要并发症。

基于术中右美托咪定镇静比丙泊酚镇静能降低术后谵妄的假设，作者使用上述镇静剂比较了老年人术后谵谵妄的发生率。

方法： 这项双盲、随机对照研究包括748名65岁或以上的患者，他们计划在2017年6月至2021年10月期间接受选择性骨科下肢手术。 根据术中使用的镇静剂（右美托咪定与丙泊酚）不同，患者以1:1的比例平均分为两组。 主要结局指标是术后谵妄发生率；是在术后的前三天，使用谵妄评估量表进行测定。

次要结局指标是平均动脉压和心率。

结果： 作者在这项治疗分析中共纳入了732名患者。 右美托咪定组的谵妄发生率低于丙泊酚组（11[3.0%]对24[6.6%]；比值比为0.42；95%可信区间为0.201至0.86；P=0.036）。 镇静期间，右美托咪定组的平均动脉压（中位[四分位间距]mmHg）（77[71至84]）高于丙泊酚组（74[69至79]；P<0.001）；然而，在麻醉后恢复室中，它显著低于（原文是低于，根据数据应该是高于）丙泊酚组（80[74-87]）Vs（74[68-80]）（P<0.001）。

在镇静期间（60[55-66]vs.63[58-70]）和麻醉后护理单元中（64[58-72]vs.68[62-77]；P<0.001），右美托咪定组的心率（次/分）均低于丙泊酚组。

结论：

在接受下肢骨科手术的健康老年人中，右美托咪定组的术后谵妄发生率低于丙泊酚组。

原文摘要 Postoperative Delirium after Dexmedetomidine versus Propofol Sedation in Healthy Older Adults Undergoing Orthopedic Lower Limb Surgery with Spinal Anesthesia:  A Randomized Controlled Trial Background:  Delirium is a critical postoperative complication in older patients. Based on the hypothesis that intraoperative dexmedetomidine sedation would lower postoperative delirium than propofol sedation would, the authors compared the incidence of postoperative delirium in older adults, using the mentioned sedatives. Methods:  This double-blinded, randomized controlled study included 748 patients, aged 65 yr or older, who were scheduled for elective lower extremity orthopedic surgery, between June 2017 and October 2021. Patients were randomized equally into two groups in a 1:1 ratio according to the intraoperative sedative used (dexmedetomidine vs. propofol). The postoperative delirium incidence was considered the primary outcome measure; it was determined using the confusion assessment method, on the first three postoperative days. The mean arterial pressure and heart rate were evaluated as secondary outcomes. Results:  The authors enrolled 732 patients in the intention-to-treat analyses. The delirium incidence was lower in the dexmedetomidine group than in the propofol group (11 [3.0%] vs. 24 [6.6%]; odds ratio, 0.42; 95% CI, 0.201 to 0.86; P = 0.036). During sedation, the mean arterial pressure (median [interquartile range] mmHg) was higher in the dexmedetomidine group (77 [71 to 84]) than in the propofol group (74 [69 to 79]; P < 0.001); however, it significantly fell lower (74 [68 to 80]) than that of the propofol group (80 [74 to 87]) in the postanesthesia care unit (P < 0.001). Lower heart rates (beats/min) were recorded with the use of dexmedetomidine than with propofol, both during sedation (60 [55 to 66] vs. 63 [58 to 70]) and in the postanesthesia care unit (64 [58 to 72] vs. 68 [62-77]; P < 0.001). Conclusions: 

Dexmedetomidine showed a lower incidence of postoperative delirium than propofol in healthy older adults undergoing lower extremity orthopedic surgery.

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱  

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