【罂粟摘要】右美托咪定辅助镇痛对骨科手术后康复的患者发生术后谵妄的影响：一项随机对照试验
右美托咪定辅助镇痛对骨科手术后康复的患者发生术后谵妄的影响：一项随机对照试验
翻译：张中伟 编辑：佟睿 审核：曹莹
贵州医科大学 麻醉与心脏电生理课题组
右美托咪定可促进正常睡眠，还可以改善镇痛效果。因此，我们提出了以下假设：在接受骨科手术后康复的老年患者中，以右美托咪定为补充的静脉镇痛可减少谵妄的发生。
在这项随机双盲对照试验中，我们招募了712名计划接受骨科大手术的老年患者（年龄65-90岁）。患者自控静脉输注的舒芬太尼用于术后镇痛，辅以随机分配的右美托咪定（1.25μg/mL）或安慰剂，持续三天。主要观察指标为每天两次用混乱评估法评估谵妄的发生率。在次要观察指标中，每天评估两次疼痛严重程度，每天评估一次睡眠质量，每次评估采用11分制，其中0分为无痛/最佳睡眠，10分为最痛/最差睡眠。
使用安慰剂组的术后谵妄发生率为7.3%（26/354），使用右美托咪啶组术后谵妄的发生率为4.8%（17/356）；相对危险度为 0.65, 95% 可信区间为 （0.36 ，1.18）; P = 0.151.右美托咪定可减轻休息时的疼痛（中位数差值为-1至0，P≤ 0.001）和在术后前5天内活动时的疼痛（中位数差值为-1，P<0.001）；它还改善了术后前3天患者的主观睡眠质量：第一天的中位数差值为-1（95%可信区间为-1到0），P=0.007; 第二天中位数差值为0（95%可信区间为-1至0），P=0.010; 第三天中位数差值为0（95%可信区间为-1到0），P=0.3，每天不良事件的发生率相似。
用小剂量右美托咪定辅助舒芬太尼静脉镇痛并不能显著减少谵妄的发生，但可以改善镇痛效果和睡眠质量，而不会引起不良事件的发生。
Hong Hong, DaZhi Zhang, Mo Li, et al. Impact of dexmedetomidine supplemented analgesia on delirium in patients recovering from orthopedic surgery: A randomized controlled trial.[J]. BMC Anesthesiol (2021) 21:223:1.
Impact of dexmedetomidine supplemented
analgesia on delirium in patients recovering from orthopedic surgery: A randomized controlled trial
Abstract
Background: Dexmedetomidine promotes normal sleep architecture; the drug also improves analgesia. We therefore tested the hypothesis that supplementing intravenous analgesia with dexmedetomidine reduces delirium in older patients recovering from orthopedic surgery.
Method:In this double‑blinded randomized controlled trial, we enrolled 712 older (aged 65–90 years) patients scheduled for major orthopedic surgery. Postoperative analgesia was provided by patient‑controlled intravenous
sufentanil, supplemented by randomly assigned dexmedetomidine (1.25 μg/mL) or placebo, for up to three days. The primary outcome was the incidence of delirium assessed twice daily with the Confusion Assessment Method. Among secondary outcomes, pain severity was assessed twice daily and sleep quality once daily, each with an 11‑point scale where 0 = no pain/the best possible sleep and 10 = the worst pain/the worst possible sleep.
Results:The incidence of postoperative delirium was 7.3% (26 of 354) with placebo and 4.8% (17 of 356) with dexmedetomidine; relative risk 0.65, 95% CI 0.36 to 1.18; P = 0.151. Dexmedetomidine reduced pain both at rest (median difference ‑1 to 0 points, P ≤ 0.001) and with movement (‑1 points, P < 0.001) throughout the first 5 postoperative days; it also improved subjective sleep quality during the first 3 postoperative days: day one median difference ‑1 point (95% CI ‑1 to 0), P = 0.007; day two 0 point (‑1 to 0), P = 0.010; and day three 0 point (‑1 to 0), P = 0.003. The incidence of adverse events was similar in each group.
Conclusion:Supplementing sufentanil intravenous analgesia with lowdose dexmedetomidine did not significantly reduce delirium, but improved analgesia and sleep quality without provoking adverse events.
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