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右美托咪定对脑肿瘤切除术后谵妄的影响:一项随机对照试验的研究方案。

Effect of dexmedetomidine on postoperative delirium in patients undergoing brain tumour resections: study protocol of a randomised controlled trial.

机构信息

Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China.

Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China

出版信息

BMJ Open. 2021 Nov 10;11(11):e051584. doi: 10.1136/bmjopen-2021-051584.

Abstract

INTRODUCTION

Postoperative delirium (POD) is a common complication. The incidence of POD is about 25% in non-cardiac surgery and ranges from 10% to 30% in neurological procedures. A lot of trials show that dexmedetomidine might help to reduce the incidence of delirium in patients undergoing non-cardiac surgery. However, the impact of dexmedetomidine on POD for patients undergoing craniotomy and tumour resections remains unclear.

METHODS AND ANALYSIS

The study is a prospective, single-centre, randomised, double-blinded, paralleled-group controlled trial. Patients undergoing elective frontotemporal tumour resections will be randomly assigned to the dexmedetomidine group and the control group. After endotracheal intubation, patients in the dexmedetomidine group will be administered with a loading dose of dexmedetomidine 0.6 µg/kg in 10 min followed by continuous infusion at a rate of 0.4 µg/kg/hour until the start of dural closure. In the control group, patients will receive the identical volume of normal saline in the same setting. The primary outcome will be the cumulative incidence of POD within 5 days. The delirium assessment will be performed by using the confusion assessment method in the first 5 consecutive days after surgery. Secondary outcomes include the pain severity assessed by Numerical Rating Scale pain score, quality of postoperative sleep assessed by the Richards Campbell sleep questionnaire and postoperative quality of recovery from anaesthesia by the Postoperative Quality Recovery Scale.

ETHICS AND DISSEMINATION

The protocol (V.1.0, 10 November 2020) has been approved by the Ethics Review Committee of the Chinese Clinical Trial Registry (number ChiECRCT-20200436). The findings of the study will be disseminated in a peer-reviewed journal and at a scientific conference.

TRIAL REGISTRATION NUMBER

NCT04674241.

摘要

简介

术后谵妄(POD)是一种常见的并发症。非心脏手术中 POD 的发生率约为 25%,神经外科手术中为 10%至 30%。大量试验表明,右美托咪定可帮助降低非心脏手术患者发生谵妄的几率。然而,右美托咪定对行颅脑部手术和肿瘤切除术患者的 POD 影响仍不清楚。

方法和分析

该研究是一项前瞻性、单中心、随机、双盲、平行组对照试验。择期行额颞部肿瘤切除术的患者将被随机分配至右美托咪定组和对照组。气管插管后,右美托咪定组患者将以 0.6μg/kg 的负荷剂量输注 10 分钟,随后以 0.4μg/kg/h 的速度持续输注,直至硬脑膜关闭开始。对照组患者将在相同条件下接受相同容量的生理盐水。主要结局是 5 天内 POD 的累积发生率。术后第 1 至 5 天每天使用意识模糊评估法进行谵妄评估。次要结局包括使用数字疼痛评分量表评估疼痛严重程度、使用 Richards Campbell 睡眠问卷评估术后睡眠质量和使用术后麻醉恢复质量量表评估术后麻醉恢复质量。

伦理和传播

方案(V.1.0,2020 年 11 月 10 日)已获得中国临床试验注册中心伦理审查委员会的批准(编号 ChiECRCT-20200436)。该研究的结果将在同行评议期刊和科学会议上发表。

试验注册编号

NCT04674241。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4936/8587577/3e82fa9649fd/bmjopen-2021-051584f01.jpg

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