Lu Zhongyuan, Sun Mingyang, Chen Wan-Ming, Lv Shuang, Fu Ningning, Yang Yitian, Wang Yangyang, Miao Mengrong, Wu Szu-Yuan, Zhang Jiaqiang
Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Academy of Medical Sciences of Zhengzhou University, Zhengzhou, Henan, China.
J Anesth. 2025 Apr 26. doi: 10.1007/s00540-025-03504-y.
The effect of metformin on postoperative delirium (POD) in patients with type 2 diabetes mellitus (T2DM) undergoing cardiovascular surgery remains unclear. This study aimed to evaluate whether metformin use reduces POD risk in this high-risk population by analyzing data from Taiwan's National Health Insurance Research Database using propensity score matching (PSM).
We included T2DM patients who underwent coronary artery bypass grafting (CABG) or valve replacement between 2015 and 2018. PSM was used to balance covariates between metformin users and non-users. Logistic regression and Kaplan-Meier analyses were performed to assess POD risk and its cumulative incidence.
Metformin use was associated with a significantly reduced risk of POD (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], 0.40-0.67). A dose-response trend was observed, with decreasing aORs for higher cumulative metformin exposure. Protective factors included higher income, urban residency, and statin use; risk factors included older age, prolonged anesthesia, higher aDCSI, CCI scores, and depression.
Metformin significantly lowers the risk of POD in T2DM patients undergoing cardiovascular surgery, showing a clear dose-dependent protective effect. These findings highlight metformin's potential as a chemopreventive agent against post-surgical complications in this population.
二甲双胍对接受心血管手术的2型糖尿病（T2DM）患者术后谵妄（POD）的影响尚不清楚。本研究旨在通过使用倾向评分匹配（PSM）分析台湾国民健康保险研究数据库的数据，评估二甲双胍的使用是否能降低这一高危人群发生POD的风险。
我们纳入了2015年至2018年间接受冠状动脉旁路移植术（CABG）或瓣膜置换术的T2DM患者。使用PSM来平衡二甲双胍使用者和非使用者之间的协变量。进行逻辑回归和Kaplan-Meier分析以评估POD风险及其累积发生率。
使用二甲双胍与POD风险显著降低相关（调整后的优势比[aOR]，0.52；95%置信区间[CI]，0.40 - 0.67）。观察到剂量反应趋势，随着二甲双胍累积暴露量增加，aOR降低。保护因素包括较高收入、城市居住和使用他汀类药物；风险因素包括年龄较大、麻醉时间延长、较高的急性生理与慢性健康状况评分系统（aDCSI）、Charlson合并症指数（CCI）评分以及抑郁症。
二甲双胍显著降低了接受心血管手术的T2DM患者发生POD的风险，显示出明显的剂量依赖性保护作用。这些发现突出了二甲双胍作为该人群术后并发症化学预防剂的潜力。
