术中使用右美托咪定对术后认知功能下降的影响：多中心随机对照试验
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A multicentre randomised controlled trial of the effect of intra-operative dexmedetomidine on cognitive decline after surgery
背景与目的
围术期使用右美托咪定可降低术后谵妄发生率。本研究旨在评估右美托咪定对术后6个月内认知功能的影响，以及其与术后第3天、第7天脑源性神经营养因子血清浓度变化的关系。
方 法
我们随机将535例年龄在65岁或65岁以上择期行开腹胃肠手术的患者分为两组：术中使用右美托咪定组(n = 269)：静脉注射0.5 μg.kg-1负荷剂量后，以0.4 μg.kg-1.hr-1的速率持续泵注右美托咪定；安慰剂组(n = 266)。
结 果
右美托咪定可降低认知障碍发生率（术后第3天：40/269 vs. 65/266, p = 0.006；术后第7天：31/269 vs. 49/266, p = 0.03；术后1个月：42/250 vs. 61/248, p = 0.04）。术后7天内的认知功能障碍与术后第3天、第7天脑源性神经营养因子浓度变化有关，ROC曲线下面积分别为0.63、p < 0.001和0.58,p = 0.016。
结 论
术中使用右美托咪定可减轻老年患者择期开腹术后一个月内的认知功能下降，这与血清脑源性神经营养因子的变化有关。
原始文献摘要
Cheng XQ, Mei B, Zuo YM, et al. A multicentre randomised controlled trial of the effect of intra-operative dexmedetomidine on cognitive decline after surgery[J]. Anaesthesia. 2019 Jun;74(6):741-750. doi: 10.1111/anae.14606.
BACKGROUND:
Peri-operative dexmedetomidine can reduce rates of delirium immediately after surgery. We aimed to assess the effect of dexmedetomidine on cognition up to six postoperative months and its association with changes in serum concentrations of brain-derived neurotrophic factor on the third and seventh postoperative days.
METHODS:
We randomly allocated 535 patients aged 65 years or more undergoing scheduled gastro-intestinal laparotomy to: intra-operative dexmedetomidine, 0.5 μg.kg-1 bolus followed by 0.4 μg.kg-1.hr-1 infusion (n = 269), or placebo (n = 266).
RESULTS:
Dexmedetomidine reduced the rate of cognitive impairment: on the third postoperative day, 40/269 vs. 65/266, p = 0.006; on the seventh postoperative day, 31/269 vs. 49/266, p = 0.03 and at one postoperative month, 42/250 vs. 61/248, p = 0.04. Cognitive impairment at seven postoperative days was associated with changes in brain-derived neurotrophic factor concentrations on the third and seventh postoperative days; area under the receiver operating characteristic curve 0.63, p < 0.001 and 0.58, p = 0.016, respectively.
CONCLUSIONS:
Intra-operative dexmedetomidine reduced cognitive decline up to one postoperative month in elderly patients undergoing scheduled laparotomy, which was associated with changes in serum brain-derived neurotrophic factor.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙