Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
Brain Behav. 2022 Aug;12(8):e2665. doi: 10.1002/brb3.2665. Epub 2022 Jul 10.
Dexmedetomidine (Dex) is suggested to be neuroprotective. However, influence of Dex on postoperative cognitive dysfunction (POCD) in the elderly remains unknown.
We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of Dex on POCD. Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results.
Fourteen RCTs including 1626 adults of 60 years or older who received surgery with general anesthesia were included. Because methodologically diverse scales were used for POCD, eight RCTs with POCD diagnosed with Mini-Mental State Examination (MMSE) were included in the meta-analysis, while the remaining six RCTs with POCD diagnosed with other scales were qualitative synthesized. Pooled results of RCTs with MMSE showed that Dex significantly reduced the incidence of POCD (risk ratio: 0.47, 95% confidence interval: 0.37-0.60, p < 0.001) with no significant heterogeneity (I = 0%) or publication bias (p for Egger's regression test = 0.579). For the remaining six RCTs with POCD diagnosed with other scales, three of them showed that Dex was associated with a significantly lower incidence of POCD, while the other three RCTs did not show a significant difference.
Dex is associated with a reduced risk of POCD in elderly patients receiving surgeries with general anesthesia, and the results were mainly obtained in studies with POCD diagnosed with MMSE. Based on these findings, Dex may be considered as a preventative measure for POCD in elderly patients.
右美托咪定（Dex）被认为具有神经保护作用。然而，其对老年人术后认知功能障碍（POCD）的影响尚不清楚。
我们对随机对照试验（RCT）进行了荟萃分析，以评估 Dex 对 POCD 的影响。通过检索 PubMed、Embase 和 Cochrane 图书馆数据库获得相关研究。使用随机效应模型对结果进行汇总。
纳入了 14 项 RCT，共包括 1626 名 60 岁或以上接受全身麻醉手术的成年人。由于 POCD 使用的方法学多样的量表，因此纳入了 8 项使用简易精神状态检查（MMSE）诊断 POCD 的 RCT 进行荟萃分析，而其余 6 项使用其他量表诊断 POCD 的 RCT 则进行定性综合分析。使用 MMSE 诊断 POCD 的 RCT 的汇总结果显示，Dex 可显著降低 POCD 的发生率（风险比：0.47，95%置信区间：0.37-0.60，p<0.001），且无显著异质性（I=0%）或发表偏倚（Egger 回归检验 p 值=0.579）。对于其余 6 项使用其他量表诊断 POCD 的 RCT，其中 3 项显示 Dex 与 POCD 的发生率显著降低相关，而另外 3 项 RCT 则未显示出显著差异。
在接受全身麻醉手术的老年患者中，Dex 与 POCD 的风险降低相关，这些结果主要来自于使用 MMSE 诊断 POCD 的研究。基于这些发现，Dex 可被视为预防老年患者 POCD 的一种措施。
