Shen Qi-Hong, Li Hui-Fang, Zhou Xu-Yan, Yuan Xiao-Zhong
Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Zhejiang, China.
Department of Gynecology, Tongxiang Maternal and Child Health Care Hospital, Tongxiang, China.
Clin Exp Pharmacol Physiol. 2020 Aug;47(8):1333-1341. doi: 10.1111/1440-1681.13312. Epub 2020 Apr 20.
The efficacy of dexmedetomidine in the prevention of postoperative delirium (POD) remains ambiguous, however, it has been used to reduce the incidence of delirium in elderly patients. Here, we conducted a meta-analysis study for assessing the effects of dexmedetomidine on POD among elderly patients following non-cardiac surgery. A systematic literature search was performed against the PubMed, EMBASE, Cochrane Library, and Web of Science databases, and all relevant literature published till November 30, 2019, were considered. Our analysis included 16 randomised controlled trials conducted with 4534 patients for exploring the effects of dexmedetomidine on POD in elderly patients following non-cardiac surgery. It was observed that the overall incidence of POD was significantly lower in the dexmedetomidine group than in the control group (risk ratio [RR] 0.51, 95% confidence interval [CI] 0.43-0.61, P < .01). Similar results were obtained from subgroup analysis upon comparison of the placebo (RR 0.52, 95% CI 0.41-0.66, P < .01, moderate quality of evidence), propofol-treated (RR 0.55, 95% CI 0.38-0.78, P < .01, low quality of evidence), and midazolam-treated (RR 0.38, 95% CI 0.20-0.71, P < .01, low quality of evidence) groups. Trial sequential analysis revealed that the cumulative z-value superseded the monitoring boundary and reached the required information size. However, patients who received dexmedetomidine had a higher incidence of bradycardia and hypotension. In conclusion, the meta-analysis revealed that dexmedetomidine appears to decrease the risk of POD in elderly patients following non-cardiac surgery. However, as some of the studies were heterogeneous and of low quality, high-quality trials are necessary for drawing more definitive conclusions.
右美托咪定预防术后谵妄（POD）的疗效仍不明确，不过，它已被用于降低老年患者谵妄的发生率。在此，我们进行了一项荟萃分析研究，以评估右美托咪定对非心脏手术后老年患者POD的影响。针对PubMed、EMBASE、Cochrane图书馆和Web of Science数据库进行了系统的文献检索，并纳入了截至2019年11月30日发表的所有相关文献。我们的分析纳入了16项随机对照试验，共4534例患者，以探讨右美托咪定对非心脏手术后老年患者POD的影响。结果发现，右美托咪定组POD的总体发生率显著低于对照组（风险比[RR]0.51，95%置信区间[CI]0.43 - 0.61，P <.01）。在与安慰剂组（RR 0.52，95% CI 0.41 - 0.66，P <.01，证据质量中等）、丙泊酚治疗组（RR 0.55，95% CI 0.38 - 0.78，P <.01，证据质量低）和咪达唑仑治疗组（RR 0.38，95% CI 0.20 - 0.71，P <.01，证据质量低）比较的亚组分析中也得到了类似结果。试验序贯分析显示，累积z值超过了监测边界并达到了所需的信息量。然而，接受右美托咪定治疗的患者心动过缓和低血压的发生率较高。总之，荟萃分析表明，右美托咪定似乎可降低非心脏手术后老年患者发生POD的风险。然而，由于部分研究存在异质性且质量较低，需要高质量的试验才能得出更明确的结论。
