Department of Anaesthesia and Intensive Care Medicine, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Anaesthesia. 2021 Oct;76(10):1342-1351. doi: 10.1111/anae.15469. Epub 2021 May 7.
Delirium occurs commonly following major non-cardiac and cardiac surgery and is associated with: postoperative mortality; postoperative neurocognitive dysfunction; increased length of hospital stay; and major postoperative complications and morbidity. The aim of this study was to investigate the effect of peri-operative administration of dexmedetomidine on the incidence of postoperative delirium in non-cardiac and cardiac surgical patients. In this randomised, double-blind placebo-controlled trial we included 63 patients aged ≥ 60 years undergoing major open abdominal surgery or coronary artery bypass graft surgery with cardiopulmonary bypass. The primary outcome was the incidence of postoperative delirium, as screened for with the Confusion Assessment Method. Delirium assessment was performed twice daily until postoperative day 5, at the time of discharge from hospital or until postoperative day 14. We found that dexmedetomidine was associated with a reduced incidence of postoperative delirium within the first 5 postoperative days, 43.8% vs. 17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care Delirium Screening Checklist, was comparable in both groups, with a mean maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the dexmedetomidine group died while five (15.6%) patients in the placebo group died, p = 0.029. For patients aged ≥ 60 years undergoing major cardiac or non-cardiac surgery, we conclude that the peri-operative administration of dexmedetomidine is associated with a lower incidence of postoperative delirium.
谵妄在非心脏和心脏手术后很常见，与以下情况相关：术后死亡率；术后神经认知功能障碍；住院时间延长；以及主要术后并发症和发病率。本研究旨在探讨围手术期给予右美托咪定对非心脏和心脏手术患者术后谵妄发生率的影响。在这项随机、双盲、安慰剂对照试验中，我们纳入了 63 名年龄≥60 岁的患者，他们接受了大的开放性腹部手术或冠状动脉旁路移植术伴体外循环。主要结局是术后谵妄的发生率，通过意识混乱评估方法进行筛查。在术后第 5 天、出院时或术后第 14 天之前，每天进行两次谵妄评估。我们发现，右美托咪定与术后前 5 天内术后谵妄发生率降低相关，分别为 43.8%和 17.9%，p=0.038。使用重症监护谵妄筛查检查表筛查的谵妄严重程度，两组相当，平均最大得分为 1.54 与 1.68，p=0.767。右美托咪定组无患者死亡，而安慰剂组有 5 例（15.6%）患者死亡，p=0.029。对于年龄≥60 岁接受大的心脏或非心脏手术的患者，我们得出结论，围手术期给予右美托咪定与术后谵妄发生率降低相关。
