Department of Anesthesiology, West China Hospital, Sichuan University & the Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, China.
Biomed Res Int. 2021 Nov 23;2021:8652028. doi: 10.1155/2021/8652028. eCollection 2021.
To evaluate whether a low-dose perioperative infusion of Dex reduces early POCD.
This study was a double-blind, randomized, placebo-controlled trial that randomly assigned patients to Dex or saline placebo infused during surgery and patient-controlled intravenous analgesia (PCIA) infusion. Patients were assessed for postoperative cognitive decline. . Dex was infused at a loading dose of 0.5 g/kg intravenously (15 min after entering the operation room) followed by a continuous infusion at a rate of 0.5 g/kg/h until one-lung ventilation or artificial pneumothorax ended. Patients in the Dex group received regular PCIA pump with additional dose of Dex (200 g).
In total, 126 patients were randomized, and 102 patients were involved in the result analysis. The incidence of POCD was 36.54% (19/52) in the Dex group and 32.00% (16/50) in the normal saline (NS) group, with no statistic difference. No significant difference was observed between the two groups in terms of Telephone Interview for Cognitive Status-Modified (TICS-m) scores at different times. However, the TICS-m score at 7 days after surgery was significantly lower than that at 30 days in 102 patients (32.93 ± 0.42 vs. 33.92 ± 0.47, = 0.03). The visual analogue scale scores in the Dex group were significantly lower than those in the NS group 1 day postoperation at rest and activity (2.00 [1.00-3.00] vs. 3.00 [2.00-4.00], < 0.01; 4.00 [3.00-5.00] vs. 5.00 [4.00-6.00], < 0.05, respectively). Patients receiving Dex or NS had no statistical difference in activities of daily living (ADLs) scores at 7 and 30 days after surgery, but the ADL score at 30 days after surgery showed a significant reduction compared with that at 7 days ( < 0.01). Patients in the Dex group had a shorter hospital length of stay (15.26 ± 3.77 vs. 17.69 ± 5.09, = 0.02) and less expenses (52458.71 ± 10649.30 vs. 57269.03 ± 9269.98, = 0.04) than those in the NS group.
Low-dose Dex in the perioperative period did not reduce the incidence of early POCD in thoracic surgery. However, it relieved postoperative pain, decreased the hospitalization expenses, and shortened the length of stay.
评估围手术期低剂量地塞米松（Dex）输注是否能减少术后早期认知障碍（POCD）。
这是一项双盲、随机、安慰剂对照试验，将患者随机分配至 Dex 组或生理盐水安慰剂组，在手术期间和患者自控静脉镇痛（PCIA）输注期间接受输注。评估患者术后认知能力下降情况。Dex 以 0.5 g/kg 的负荷剂量静脉推注（进入手术室后 15 分钟），然后以 0.5 g/kg/h 的速度持续输注，直至单肺通气或人工气胸结束。Dex 组患者接受常规 PCIA 泵，额外给予 Dex（200 g）。
共有 126 名患者被随机分组，102 名患者纳入结果分析。Dex 组的 POCD 发生率为 36.54%（19/52），生理盐水（NS）组为 32.00%（16/50），无统计学差异。两组在不同时间的电话访谈认知状态修正量表（TICS-m）评分方面无显著差异。然而，102 名患者中术后第 7 天的 TICS-m 评分明显低于第 30 天（32.93±0.42 比 33.92±0.47， = 0.03）。术后第 1 天静息和活动时，Dex 组的视觉模拟评分明显低于 NS 组（2.00[1.00-3.00]比 3.00[2.00-4.00]， < 0.01；4.00[3.00-5.00]比 5.00[4.00-6.00]， < 0.05）。术后第 7 和第 30 天，接受 Dex 或 NS 的患者在日常生活活动（ADL）评分方面无统计学差异，但术后第 30 天的 ADL 评分明显低于第 7 天（ < 0.01）。Dex 组患者的住院时间（15.26±3.77 比 17.69±5.09， = 0.02）和费用（52458.71±10649.30 比 57269.03±9269.98， = 0.04）均短于 NS 组。
围手术期低剂量 Dex 并未降低胸部手术患者早期 POCD 的发生率。然而，它缓解了术后疼痛，减少了住院费用，缩短了住院时间。
