Huang Cuifang, Yang Ruimin, Xie Xianlong, Dai Huijun, Pan Linghui
Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, China.
Guangxi Clinical Research Center for Anesthesiology (GKAD22035214), Nanning, China.
Front Neurol. 2024 Aug 12;15:1422049. doi: 10.3389/fneur.2024.1422049. eCollection 2024.
Dexmedetomidine (DEX) has demonstrated potential as an effective agent for enhancing early postoperative cognitive function. However, there is ongoing debate regarding its optimal dosage and impact on early postoperative inflammatory response. This study aimed to assess and prioritize the effects of varying doses of DEX on early postoperative cognitive function and inflammatory response, in order to identify the most effective intervention dosage.
Randomised controlled trials (RCTs) and retrospective cohort studies (RCS) from PubMed, Embase, and Cochrane Library up to January 28, 2024, were included. The Mini-Mental State Examination (MMSE) was utilized to assess the impact of varying doses of DEX on cognitive function during the early postoperative period as the primary outcome, peripheral blood levels of IL-6 and TNF-α were considered as secondary outcomes. Meta-analysis and Bayesian Network Meta-Analysis (NMA) were conducted using R. Funnel plots were generated using Stata 15.0.
A total of 29 studies involving 2,807 patients and 25 different doses of DEX were included. DEX was given at a loading dose of 0.3-1.0 μg/kg followed by a maintenance dose of 0.1-0.5 μg/kg/h, or at a uniform intraoperative dose of 0.4-0.7 μg/kg/h. Network meta-analysis revealed most doses of DEX were significantly more effective than normal saline (NS) in improving postoperative MMSE scores (on days 1, 3, and 7) and lowering IL-6 and TNF-α levels. Probability results showed that a 1 μg/kg loading dose followed by a 0.6 μg/kg/h maintenance dose was the best dosing regimen for improving MMSE scores on postoperative days 1 (97.3%), 3 (100%), and 7 (99.9%), as well as for reducing postoperative blood IL-6 levels (1.3%). On the other hand, 0.3 μg/kg followed by 0.2 μg/kg/h was the optimal dosing regimen for reducing postoperative blood TNF-α levels (6.6%).
Compared with NS, intraoperative intravenous DEX improved early postoperative cognitive function and postoperative inflammatory response in patients undergoing elective surgery. In particular, a 1 μg/kg loading dose and a 0.6 μg/kg/h maintenance dose resulted in the best improvement in postoperative MMSE scores and blood IL-6 levels, while a 0.3 μg/kg loading dose followed by a 0.2 μg/kg/h maintenance dose is the optimal regimen for lowering postoperative blood TNF-α levels.: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=433932, identifier CRD42023433932.
右美托咪定（DEX）已显示出作为增强术后早期认知功能的有效药物的潜力。然而，关于其最佳剂量及其对术后早期炎症反应的影响仍存在争议。本研究旨在评估不同剂量的DEX对术后早期认知功能和炎症反应的影响并进行优先级排序，以确定最有效的干预剂量。
纳入截至2024年1月28日来自PubMed、Embase和Cochrane图书馆的随机对照试验（RCT）和回顾性队列研究（RCS）。采用简易精神状态检查表（MMSE）评估不同剂量的DEX在术后早期对认知功能的影响作为主要结局，外周血白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平作为次要结局。使用R软件进行荟萃分析和贝叶斯网络荟萃分析（NMA）。使用Stata 15.0生成漏斗图。
共纳入29项研究，涉及2807例患者和25种不同剂量的DEX。DEX的负荷剂量为0.3 - 1.0μg/kg，随后维持剂量为0.1 - 0.5μg/kg/h，或术中统一剂量为0.4 - 0.7μg/kg/h。网络荟萃分析显示，大多数剂量的DEX在改善术后MMSE评分（术后第1天、3天和7天）以及降低IL-6和TNF-α水平方面明显比生理盐水（NS）更有效。概率结果表明，负荷剂量1μg/kg随后维持剂量0.6μg/kg/h是改善术后第1天（97.3%）、3天（100%）和7天（99.9%）MMSE评分以及降低术后血IL-6水平（1.3%）的最佳给药方案。另一方面，0.3μg/kg随后0.2μg/kg/h是降低术后血TNF-α水平（6.6%）的最佳给药方案。
与NS相比，术中静脉注射DEX可改善择期手术患者的术后早期认知功能和术后炎症反应。特别是，负荷剂量1μg/kg和维持剂量0.6μg/kg/h在改善术后MMSE评分和血IL-6水平方面效果最佳，而负荷剂量0.3μg/kg随后维持剂量0.2μg/kg/h是降低术后血TNF-α水平的最佳方案。：https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=433932，标识符CRD42023433932
