Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China.
Department of Anesthesiology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China.
Int J Geriatr Psychiatry. 2021 Jan;36(1):143-151. doi: 10.1002/gps.5406. Epub 2020 Nov 10.
Delirium is the most common postoperative neurological complication and some evidence suggests that dexmedetomidine is associated with a decreased incidence of delirium. This study is designed to assess the effect of dexmedetomidine on postoperative delirium (POD) in elderly patients with mild cognitive impairment (MCI).
Sixty geriatric patients with MCI were enrolled and ramdomly divided into two groups by a computer-generated randomisation sequence: dexmedetomidine group (D group) and normal saline group (C group). Patients in D group received a loading dose of 0.5 μg/kg dexmedetomidine over 10 minutes before anesthesia induction, followed by a continuous infusion of 0.4 μg·kg·h until 30 minutes before the end of surgery; equal volume of normal saline was given in C group. Blood samples were extracted to detect the concentration of cytokines, including tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), heme oxygenase-1 (HO-1), matrix metalloproteinase-9 (MMP-9), and glial fibrillary acidic protein (GFAP) before anesthesia induction (T), before suture (T), and 30 minutes after surgery (T). Postoperative recovery times were recorded. Delirium was assessed with the 3-Minute Diagnostic Interview for confusion assessment method during the first 7 days postoperatively.
POD occurred in 10 (33.3%) of 30 patients in C group, and in 3 (10%) of 30 patients given dexmedetomidine (odds ratio [OR] 0.222, 95% CI 0.054-0.914; P = 0.028). The serum concentrations of TNF-α, MMP-9, and GFAP were significantly increased and IL-10 was decreased in the C group than in the D group at T and T. No differences were observed between groups in the level of HO-1. Analysis using random-effect multivariable logistic regression indicated that POD was associated with GFAP (odds ratio [OR] 16.691, 95% CI 2.288-121.746; P = 0.005). The positive predictive ability of the multivariate logistic regression model tested by ROC analysis showed an area under the curve of 0.713 (95% CI, 0.584-0.842).
Dexmedetomidine can alleviate POD in elderly patients with MCI and may be related to reduce the neuroinflammation by lowering the permeability of blood-brain barrier.
谵妄是最常见的术后神经系统并发症，有证据表明右美托咪定可降低谵妄发生率。本研究旨在评估右美托咪定对伴有轻度认知障碍（MCI）的老年患者术后谵妄（POD）的影响。
本研究纳入 60 例 MCI 老年患者，采用计算机生成的随机序列将其分为两组：右美托咪定组（D 组）和生理盐水组（C 组）。D 组患者在麻醉诱导前 10 分钟内给予负荷剂量 0.5μg/kg 右美托咪定，随后以 0.4μg·kg·h 的速度持续输注至手术结束前 30 分钟；C 组给予等容量生理盐水。在麻醉诱导前（T）、缝合前（T）和术后 30 分钟（T）时提取血样检测细胞因子浓度，包括肿瘤坏死因子-α（TNF-α）、白细胞介素-10（IL-10）、血红素加氧酶-1（HO-1）、基质金属蛋白酶-9（MMP-9）和胶质纤维酸性蛋白（GFAP）。记录术后恢复时间。术后第 1 至 7 天采用 3 分钟诊断性谵妄评估法评估谵妄。
C 组 30 例患者中有 10 例（33.3%）发生 POD，而给予右美托咪定的 30 例患者中有 3 例（10%）发生 POD（比值比 [OR] 0.222，95%CI 0.054-0.914；P=0.028）。与 D 组相比，C 组在 T 和 T 时 TNF-α、MMP-9 和 GFAP 血清浓度显著升高，IL-10 降低，而两组间 HO-1 水平无差异。采用随机效应多变量逻辑回归分析表明，POD 与 GFAP 相关（比值比 [OR] 16.691，95%CI 2.288-121.746；P=0.005）。ROC 分析对多变量逻辑回归模型的阳性预测能力显示曲线下面积为 0.713（95%CI，0.584-0.842）。
右美托咪定可减轻伴有 MCI 的老年患者的 POD，可能与通过降低血脑屏障通透性减轻神经炎症有关。
