地塞米松对心脏手术后早期认知功能下降的影响：一项随机对照试验。

Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial.

机构信息

From the Clinical Department of Anaesthesiology and Intensive Care, University Hospital of Split (SG, NK), The Department of Psychology, Faculty of Humanities and Social Sciences, University of Split (GK), The Clinical Department of Neurology (LS), The Department of Medical Laboratory Diagnostics, University Hospital of Split (DS-D); and The Department of Anaesthesiology and Intensive Medicine, School of Medicine, University of Split, Split, Croatia (NK).

出版信息

Eur J Anaesthesiol. 2017 Nov;34(11):776-784. doi: 10.1097/EJA.0000000000000647.

DOI:10.1097/EJA.0000000000000647

PMID:28985195

Abstract

BACKGROUND

Postoperative cognitive decline (POCD), a very common complication after cardiac surgery, is characterised by impairment of both memory function and intellectual ability as well as being associated with increased use of healthcare resources. The investigators focused on the role of the inflammatory response to a surgical procedure as a potential factor involved in the pathogenesis of POCD.

OBJECTIVE

The use of prophylactic dexamethasone to attenuate the inflammatory response was hypothesised to reduce the risk of POCD.

DESIGN

Randomised controlled study.

SETTING

Single university teaching hospital, from March 2015 to January 2016.

PATIENTS

A total of 169 patients scheduled for elective cardiac surgery were enrolled, and 161 patients were included in the analyses.

INTERVENTION

Patients were randomised to receive a single intravenous bolus of 0.1 mg kg dexamethasone (n = 85) or placebo (n = 84) 10 h before the surgery.

MAIN OUTCOME MEASURES

The primary outcome measure in both groups was the incidence of POCD on the 6th day after surgery. The investigators also evaluated the effect of dexamethasone on the incidence of systemic inflammatory response syndrome, postoperative C-reactive protein levels and postoperative serum S100β protein levels.

RESULTS

Compared to the placebo group, the dexamethasone group showed statistically significant reductions in the incidence of POCD (relative risk, 0.43; 95% confidence interval, 0.21 to 0.89; P = 0.02), the incidence of systemic inflammatory response syndrome (30.0 versus 58.0%, P < 0.001) and postoperative C-reactive protein levels (P < 0.001). Postoperative S100β levels were insignificantly lower (P = 0.56) in the dexamethasone group.

CONCLUSION

Preoperative administration of dexamethasone reduced the inflammatory response and thereby decreased the risk of early POCD after cardiac surgery.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT02767713.

摘要

背景

术后认知功能障碍（POCD）是心脏手术后非常常见的并发症，其特征是记忆功能和智力能力受损，并与增加医疗资源的使用有关。研究人员专注于手术引起的炎症反应作为参与 POCD 发病机制的潜在因素的作用。

目的

使用预防性地塞米松来减轻炎症反应，假设可以降低 POCD 的风险。

设计

随机对照研究。

地点

单所大学教学医院，2015 年 3 月至 2016 年 1 月。

患者

共纳入 169 例择期心脏手术患者，其中 161 例患者纳入分析。

干预措施

患者随机接受单次静脉推注 0.1mg/kg 地塞米松（n=85）或安慰剂（n=84），手术前 10 小时。

主要观察指标

两组的主要观察指标均为术后第 6 天 POCD 的发生率。研究人员还评估了地塞米松对全身炎症反应综合征、术后 C 反应蛋白水平和术后血清 S100β蛋白水平的影响。

结果

与安慰剂组相比，地塞米松组 POCD 的发生率显著降低（相对风险，0.43；95%置信区间，0.21 至 0.89；P=0.02），全身炎症反应综合征的发生率（30.0 与 58.0%，P<0.001）和术后 C 反应蛋白水平（P<0.001）。地塞米松组术后 S100β水平明显较低（P=0.56）。