右美托咪定预防成人心脏手术后谵妄：一项随机对照试验的荟萃分析。

Dexmedetomidine for delirium prevention in adult patients following cardiac surgery: a meta-analysis of randomized controlled trials.

作者信息

Meng Chang, Wang Duo, Zhao Yue, Sun Jing, Miao Guobin, Chen Lijuan, Bai Ying, Liu Peng

机构信息

Department of Emergency, Emergency General Hospital, XiBaHe South Road 29, Beijing, 100028, P. R. China.

Department of General Medicine, Ordos School of Clinical Medicine, Ordos Central Hospital, Inner Mongolia Medical University, Ordos, 017000, P. R. China.

出版信息

J Cardiothorac Surg. 2025 Jan 31;20(1):110. doi: 10.1186/s13019-025-03360-7.

OBJECTIVES

To determine whether perioperative administration of dexmedetomidine reduces the incidence of postoperative delirium in adult patients undergoing cardiac surgery.

METHODS

We searched the PubMed, Embase and Cochrane Library databases for randomized controlled trials from the last 10 years up to March 10, 2024. We then conducted a meta-analysis to evaluate the effectiveness and safety of dexmedetomidine in preventing delirium after cardiac surgery in adults. This meta-analysis followed the steps in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA2020) guidelines. This study is registered with INPLASY under number INPLASY202430132.

RESULTS

A total of 2689 patients were included in our analyses. All included studies were randomized controlled trials. Dexmedetomidine can reduce the occurrence of delirium in patients after cardiac surgery(OR 0.75, 95%CI 0.57-0.98, I = 12%, P = 0.04). In terms of other end events, length of intensive care unit(ICU) stay(MD -0.16, 95%CI -1.85-1.53, I = 0%, P = 0.85) and mortality(OR 1.59, 95%CI 0.74-3.42, I = 0%, P = 0.23) were not statistically different with dexmedetomidine compared with placebo. Bradycardia (OR 0.85, 95%CI 0.54 ~ 1.34, I = 72%, P = 0.49) and hypotension (OR 1.97, 95%CI 0.96 ~ 4.03, I = 84%, P = 0.06) were not significantly different between the two groups.

CONCLUSIONS

Dexmedetomidine is safe for cardiac surgery patients and to some extent reduces the incidence of delirium in cardiac surgery patients, which is more important in preoperative use.

目的

确定围手术期给予右美托咪定是否能降低接受心脏手术的成年患者术后谵妄的发生率。

方法

我们检索了截至2024年3月10日的过去10年的PubMed、Embase和Cochrane图书馆数据库中的随机对照试验。然后我们进行了一项荟萃分析，以评估右美托咪定在预防成人心脏手术后谵妄方面的有效性和安全性。这项荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA2020）指南中的步骤。本研究已在INPLASY注册，注册号为INPLASY202430132。

结果

我们的分析共纳入2689例患者。所有纳入研究均为随机对照试验。右美托咪定可降低心脏手术后患者谵妄的发生率（OR 0.75，95%CI 0.57-0.98，I=12%，P=0.04）。在其他终点事件方面，与安慰剂相比，右美托咪定组的重症监护病房（ICU）住院时间（MD -0.16，95%CI -1.85-1.53，I=0%，P=0.85）和死亡率（OR 1.59，95%CI 0.74-3.42，I=0%，P=0.23）无统计学差异。心动过缓（OR 0.85，95%CI 0.54~~1.34，I=72%，P=0.49）和低血压（OR 1.97，95%CI 0.96~~4.03，I=84%，P=0.06）在两组之间无显著差异。