The 904th Hospital of Joint Logistic Support Force, Department of drug distribution center - Wuxi, China.
The 904th Hospital of Joint Logistic Support Force, Department of oncology - Wuxi, China.
Rev Assoc Med Bras (1992). 2022 Sep;68(9):1166-1171. doi: 10.1590/1806-9282.20210696.
This study aims to evaluate the effectiveness of dexmedetomidine in reducing the occurrence of postoperative delirium in elderly patients after total hip joint replacement.
Patients who have undergone total hip joint replacement and who were admitted to the hospital from August 1, 2017, to August 1, 2020, were included in this study. After initial screening, 327 out of 385 patients were selected and randomly assigned to either dexmedetomidine (0.1 μg/kg/h, n=163) or placebo (n=164) groups. The occurrence of delirium was examined twice a day for one week by using the Confusion Assessment Method. Furthermore, 30-day all-cause mortality, hospitalization duration and costs, and the presence of any postoperative complications were also evaluated.
The postoperative delirium incidence was significantly lower in the dexmedetomidine group compared to that in the placebo group (13.8 vs. 29.3%, p<0.01). The hospitalization duration (17.2±6.3 vs. 15.6±4.2, p=0.006) and cost (4.5±0.9 vs. 4.9±1.1, p=0.001) in the dexmedetomidine group were also lower than those in the placebo group. Meanwhile, no significant difference between the 30-day all-cause mortality of the two groups was observed (p=0.60). In terms of safety, no significant differences between the occurrence of hypotension and bradycardia were also observed.
Our findings show that the dexmedetomidine medication can reduce the postoperative delirium incidence in older total hip joint replacement patients and can subsequently decrease the related hospitalization duration and cost of these patients.
本研究旨在评估右美托咪定在减少老年全髋关节置换术后谵妄发生的效果。
纳入 2017 年 8 月 1 日至 2020 年 8 月 1 日期间行全髋关节置换术且住院的患者。经过初步筛选，从 385 名患者中选择了 327 名患者，并将其随机分为右美托咪定（0.1μg/kg/h，n=163）或安慰剂（n=164）组。通过使用意识模糊评估方法（CAM）每天两次检查谵妄发生情况，持续一周。还评估了 30 天全因死亡率、住院时间和费用以及任何术后并发症的发生情况。
与安慰剂组相比，右美托咪定组术后谵妄发生率显著降低（13.8%比 29.3%，p<0.01）。右美托咪定组的住院时间（17.2±6.3比 15.6±4.2，p=0.006）和费用（4.5±0.9比 4.9±1.1，p=0.001）也低于安慰剂组。同时，两组 30 天全因死亡率无显著差异（p=0.60）。在安全性方面，低血压和心动过缓的发生率也无显著差异。
本研究结果表明，右美托咪定可降低老年全髋关节置换术后谵妄的发生率，从而降低这些患者的相关住院时间和费用。
