药物与POD | 右美托咪定和利多卡因能预防POD吗？

以下文章来源于小麻哥的日常 ，作者两只小绵羊

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

右美托咪定和利多卡因对老年胸腔镜手术患者应激反应和术后谵妄影响的比较：一项随机对照试验

目的：  

我们研究了术中静脉输注利多卡因或右美托咪定对胸腔镜手术患者炎症因素和认知功能的影响。

患者和方法：

年龄>65岁接受选择性胸腔镜肺叶切除术或节段切除术的患者随机分为右美托咪定组（D组）、利多卡因组（L组）和对照组（C组）。麻醉前（T0）、术后即刻（T1）、24小时（T2）和48小时（T3）测量血浆皮质醇、白细胞介素-6和肿瘤坏死因子-α浓度。术后第2天和第7天通过3D-CAM评估谵妄（Postoperative delirium，POD）。

结果：

与T0时相比，所有组的皮质醇浓度在T1时下降，而在T2时明显升高。

L组在T1和T2时的白细胞介素-6浓度显著低于其他组（P＜0.05）。

所有组在T1、T2和T3时的白介素-6浓度均显著高于T0，D组和L组在T 1和T2时显著低于C组（P＞0.05），L组在T2时显著低于D组（P<0.05）。

所有组在T1、T2和T3时肿瘤坏死因子-α浓度均显著高于T0，在T1和T2时D组和L组显著低于C组（P<0.05。

在第2天和第7天，三组之间的POD术后发生率没有统计学上的显著差异。

结论：

术中持续静脉输注利多卡因或右美托咪定可减轻手术应激和炎症反应。

利多卡因对手术应激的抑制作用在术后24小时内保持显著，而不影响患者苏醒。

然而，两种药物的给药均未能预防术后POD。

关键词：

谵妄；右美托咪定；老年人；炎症反应；利多卡因；胸腔镜手术。

原文摘要  

Comparison of the Effects of Dexmedetomidine and Lidocaine on Stress Response and Postoperative Delirium of Older Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial

Purpose:We investigated the effects of intraoperative intravenous lidocaine or dexmedetomidine infusion on inflammatory factors and cognitive function in patients undergoing thoracoscopic surgery.

Patients and methods:Patients aged >65 years undergoing elective thoracoscopic lobectomy or segmentectomy were randomly grouped as dexmedetomidine group (group D), lidocaine group (group L), and control group (group C). The plasma cortisol, interleukin-6, and tumor necrosis factor-α concentrations were measured before anesthesia (T0) and immediately (T1), 24 h (T2), and 48 h postoperatively (T3). Postoperative delirium (POD) was assessed by 3D-CAM on days 2 and 7.

Results:The cortisol concentrations decreased for all groups at T1 from T0 although they were significantly higher at T2. Group L had significantly lower interleukin-6 concentrations at T1 and T2 than the other groups (P<0.05). The interleukin-6 concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups, significantly lower for groups D and L than for group C at T1 and T2 (P<0.05), and significantly lower for group L than for group D at T2 (P<0.05). The tumor necrosis factor-α concentrations were significantly higher at T1, T2, and T3 than at T0 for all the groups and significantly lower for groups D and L than for group C at T1 and T2 (P<0.05), although they were not statistically significantly different for groups D and L. There were no statistically significant differences in the postoperative incidence of POD between the three groups on days 2 and day 7.

Conclusion:Intraoperative continuous intravenous lidocaine or dexmedetomidine infusion reduced surgical stress and inflammatory responses. The inhibitory effect of lidocaine on surgical stress remained significant for up to 24 h postoperatively without affecting patient awakening. However, the administration of either drug failed to prevent postoperative POD.

Keywords:delirium; dexmedetomidine; elderly; inflammation; lidocaine; thoracoscopic surgery.

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。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：MiLu.米鹭

校对：Michel.米萱

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