Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, 541001, PR China; Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, PR China.
Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, 541001, PR China.
J Clin Anesth. 2021 Oct;73:110308. doi: 10.1016/j.jclinane.2021.110308. Epub 2021 Apr 28.
To evaluate the efficacy of perioperative dexmedetomidine (DEX) administration for preventing delirium in adults after non-cardiac surgery.
Systematic review and meta-analysis of randomized controlled trials (RCTs).
Perioperative administration of DEX to prevent delirium in adults following non-cardiac surgery.
The incidence of postoperative delirium (POD).
The databases of PubMed, Embase and Cochrane Central Register were searched from inception to Mar 4, 2021 for all available RCTs that assessed DEX for POD in adults after non-cardiac surgery. Risk ratio (RR) with a 95% confidence interval (CI) was calculated for dichotomous data. Standardized mean difference (SMD) was calculated for continuous data. Risk of bias was assessed using the second version of the Cochrane risk-of-bias tool for RCTs (RoB 2.0), and the level of certainty for main outcomes were assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.
Thirteen studies, including the meta-analysis with a total of 4015 patients (DEX group: 2050 patients; placebo group: 1965 patients), showed that DEX significantly reduced the incidence of POD in adults after non-cardiac surgery compared with control group (RR: 0.60; 95%CI: 0.46 to 0.77, P = 0.0001, I = 55%, GRADE = moderate). Meanwhile, there was a statistical difference by the subgroup analysis between the mean age ≥ 65 years group and the mean age<65 years group. There were no statistical differences in length of hospital stay following surgery (SMD: -0.36; 95%CI: -0.80 to 0.07, P = 0.1, I = 97%, GRADE = low) and all-cause mortality rate (RR:0.57; 95%CI: 0.25 to 1.28, P < 0.17, I = 0%, GRADE = moderate) compared with placebo group. However, Meta-analysis showed that DEX administration significantly resulted in intraoperative bradycardia when compared with placebo group (RR: 1.39; 95%CI: 1.14 to 1.69, P = 0.0009, I = 0%, GRADE = high), and as well as intraoperative hypotension (RR: 1.25; 95%CI: 1.11 to 1.42, P = 0.0004, I = 0%, GRADE = high).
This systematic review and meta-analysis suggests that perioperative administration of DEX could significantly reduce the incidence of POD in patients elder than 65 years following non-cardiac surgery. However, there was no definite evidence that perioperative DEX could reduce the incidence of POD in patients younger than 65 years of age after non-cardiac surgery. In addition, perioperative DEX administration was associated with an elevated risk of bradycardia and hypotension.
评估围手术期给予右美托咪定（DEX）预防非心脏手术后成人谵妄的疗效。
随机对照试验（RCT）的系统评价和荟萃分析。
围手术期给予 DEX 预防非心脏手术后成人谵妄。
术后谵妄（POD）的发生率。
从数据库 PubMed、Embase 和 Cochrane Central Register 中检索了截至 2021 年 3 月 4 日的所有关于非心脏手术后 DEX 预防 POD 的 RCT 研究。计算二分类数据的风险比（RR）。计算连续数据的标准化均数差（SMD）。使用 Cochrane 偏倚风险评估工具第二版（RoB 2.0）评估偏倚风险，并使用推荐评估、制定与评估（GRADE）方法评估主要结局的证据确定性。
共纳入 13 项研究，包括荟萃分析，共有 4015 例患者（DEX 组：2050 例；安慰剂组：1965 例），结果显示，与对照组相比，DEX 显著降低了非心脏手术后成人 POD 的发生率（RR：0.60；95%CI：0.46 至 0.77，P=0.0001，I²=55%，GRADE=中度）。同时，在年龄≥65 岁组和年龄<65 岁组的亚组分析中存在统计学差异。术后住院时间（SMD：-0.36；95%CI：-0.80 至 0.07，P=0.1，I²=97%，GRADE=低）和全因死亡率（RR：0.57；95%CI：0.25 至 1.28，P<0.17，I²=0%，GRADE=中度）与安慰剂组相比无统计学差异。然而，荟萃分析显示，与安慰剂组相比，DEX 给药显著导致术中心动过缓（RR：1.39；95%CI：1.14 至 1.69，P=0.0009，I²=0%，GRADE=高）和术中低血压（RR：1.25；95%CI：1.11 至 1.42，P=0.0004，I²=0%，GRADE=高）。
本系统评价和荟萃分析表明，围手术期给予 DEX 可显著降低非心脏手术后 65 岁以上患者 POD 的发生率。然而，没有明确的证据表明围手术期 DEX 可以降低非心脏手术后 65 岁以下患者 POD 的发生率。此外，围手术期 DEX 给药与心动过缓和低血压的风险增加相关。
