Department of Cardiopulmonary Bypass, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
BMC Anesthesiol. 2024 Sep 17;24(1):332. doi: 10.1186/s12871-024-02715-2.
Dexmedetomidine is considered to have neuroprotective effects and may reduce postoperative delirium in both cardiac and major non-cardiac surgeries. Compared with non-cardiac surgery, the delirium incidence is extremely high after cardiac surgery, which could be caused by neuroinflammation induced by surgical stress and CPB. Thus, it is essential to explore the potential benefits of dexmedetomidine on the incidence of delirium in cardiac surgery under CPB.
Randomized controlled trials studying the effect of perioperative dexmedetomidine on the delirium incidence in adult patients undergoing cardiac surgery with CPB were considered to be eligible. Data collection was conducted by two reviewers independently. The pre-specified outcome of interest is delirium incidence. RoB 2 was used to perform risk of bias assessment by two reviewers independently. The random effects model and Mantel-Haenszel statistical method were selected to pool effect sizes for each study.
PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception to June 28, 2023. Sixteen studies including 3381 participants were included in our systematic review and meta-analysis. Perioperative dexmedetomidine reduced the incidence of postoperative delirium in patients undergoing cardiac surgery with CPB compared with the other sedatives, placebo, or normal saline (RR 0.57; 95% CI 0.41-0.79; P = 0.0009; I = 61%).
Perioperative administration of dexmedetomidine could reduce the postoperative delirium occurrence in adult patients undergoing cardiac surgery with CPB. However, there is relatively significant heterogeneity among the studies. And the included studies comprise many early-stage small sample trials, which may lead to an overestimation of the beneficial effects. It is necessary to design the large-scale RCTs to further confirm the potential benefits of dexmedetomidine in cardiac surgery with CPB.
CRD42023452410.
右美托咪定被认为具有神经保护作用，可降低心脏和非心脏大手术患者术后谵妄的发生率。与非心脏手术相比，心脏手术后谵妄的发生率极高，这可能是由手术应激和体外循环引起的神经炎症引起的。因此，有必要探讨心脏手术体外循环期间右美托咪定对谵妄发生率的潜在益处。
符合条件的研究为随机对照试验，研究了围手术期右美托咪定对接受体外循环心脏手术的成年患者谵妄发生率的影响。由两名审查员独立进行数据收集。预先指定的感兴趣结局是谵妄发生率。由两名审查员独立使用 RoB 2 评估偏倚风险。选择随机效应模型和 Mantel-Haenszel 统计方法对每项研究的效应量进行汇总。
系统检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science，检索时间截至 2023 年 6 月 28 日。本系统评价和荟萃分析纳入了 16 项研究，共 3381 名参与者。与其他镇静剂、安慰剂或生理盐水相比，围手术期右美托咪定可降低接受体外循环心脏手术患者的术后谵妄发生率（RR 0.57；95%CI 0.41-0.79；P = 0.0009；I²=61%）。
围手术期给予右美托咪定可降低接受体外循环心脏手术患者的术后谵妄发生率。然而，研究之间存在较大的异质性。并且纳入的研究包含许多早期小样本试验，这可能导致对有益效果的高估。有必要设计大规模 RCT 进一步证实心脏手术体外循环中右美托咪定的潜在益处。
CRD42023452410。
