【罂粟摘要】围手术期使用右美托咪定对心脏及非心脏手术患者术后谵妄发生率的影响:一项随机、双盲安慰剂对照试验
围手术期使用右美托咪定对心脏及非心脏手术患者术后谵妄发生率的影响:一项随机、双盲安慰剂对照试验
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
谵妄通常发生在重大的心脏及非心脏手术后，并与术后死亡率、术后神经认知功能障碍、住院时间延长、术后主要并发症及发病率相关 。本研究目的是探讨围手术期使用右美托咪定对心脏手术和非心脏手术患者术后谵妄发生率的影响。在此项随机、双盲、安慰剂对照试验中，共纳入63例年龄≥60岁的患者，且在体外循环下接受腹部大手术或冠状动脉搭桥术。主要的结果是观察术后谵妄发生率，并用混淆评估法进行筛查；谵妄评估每天进行两次，直到术后第5天、出院时或术后第14天。试验结果发现右美托咪定与术后5天内谵妄发生率降低相关，为43.8% vs 17.9%， p = 0.038；用重症监护妄想筛查表筛查的妄想严重程度在两组中具有相似性，平均最高得分分别为1.54 vs 1.68，p=0.767；右美托咪啶组无患者死亡，而安慰剂组有5名患者(15.6%)死亡，p=0.029。对于年龄≥60岁接受重大心脏或非心脏手术的患者，得出结论是，围手术期使用右美托咪定与术后谵妄发生率较低相关。
The effect of peri-operative dexmedetomidine on the incidence of postoperative delirium in cardiac and non-cardiac surgical patients: a randomised, double-blind placebo-controlled trial
Delirium occurs commonly following major non-cardiac and cardiac surgery and is associated with: postoperative mortality; postoperative neurocognitive dysfunction; increased length of hospital stay; and major postoperative complications and morbidity. The aim of this study was to investigate the effect of peri-operative administration of dexmedetomidine on the incidence of postoperative delirium in non-cardiac and cardiac surgical patients. In this randomised, double-blind placebo-controlled trial we included 63 patients aged ≥ 60 years undergoing major open abdominal surgery or coronary artery bypass graft surgery with cardiopulmonary bypass. The primary outcome was the incidence of postoperative delirium, as screened for with the Confusion Assessment Method. Delirium assessment was performed twice daily until postoperative day 5, at the time of discharge from hospital or until postoperative day 14. We found that dexmedetomidine was associated with a reduced incidence of postoperative delirium within the first 5 postoperative days, 43.8% vs. 17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care Delirium Screening Checklist, was comparable in both groups, with a mean maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the dexmedetomidine group died while five (15.6%) patients in the placebo group died, p = 0.029. For patients aged ≥ 60 years undergoing major cardiac or non-cardiac surgery, we conclude that the peri-operative administration of dexmedetomidine is associated with a lower incidence of postoperative delirium.
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