Hao Xinyu, Zhang Zhuoning, Yang Lujia, Guo Yongxin, Cao Fuyang, Cao Jiangbei, Liu Yanhong, Lou Jingsheng, Xu Ziyao, Cui Yulong, Bai Yunxiao, Gu Xiaoping, Wang Difen, Cui Qianyu, Zhou Zhikang, Shen Hao, Sun Jingjia, Mi Weidong, Tong Li
Department of Anesthesiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Department of Anesthesiology, The Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China.
CNS Neurosci Ther. 2025 May;31(5):e70407. doi: 10.1111/cns.70407.
Neuropsychiatric symptoms significantly impact surgical recovery, quality of life, and long-term survival. To investigate the association between intraoperative dexmedetomidine administration and the incidence of postoperative depressive symptoms in noncardiac surgical patients.
A multicenter prospective observational study of older surgical patients over 65 years of age from April 2020 to April 2022. The primary outcome was the incidence of postoperative 7-day depressive symptoms. Secondary outcomes were the incidence of postoperative 7-day anxiety symptoms, sleep disturbance, and delirium. A logistic regression model based on the random effect was used to determine the association between dexmedetomidine administration and the outcomes. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were employed to address data imbalance. Subgroup analyses based on specific populations were performed to explore the relationship between dexmedetomidine and depressive symptoms.
Of 5591 patients, 20.5% (1148) received intraoperative dexmedetomidine. The incidence of postoperative 7-day depressive symptoms was significantly lower in the dexmedetomidine group compared to the nondexmedetomidine group (unadjusted: 7.6% vs. 26.7%, p < 0.001; PSM: 7.9% vs. 29.0%, IPTW: 8.7% vs. 25.8%, p < 0.001). Dexmedetomidine was significantly associated with the remission of postoperative 7-day depressive symptoms (adjusted random-effect model: risk ratio [RR] 0.104, 95% CI, 0.080-0.140, p < 0.001; PSM: RR 0.311, 95% CI, 0.242-0.415, p < 0.001; IPTW: RR 0.297, 95% CI, 0.253-0.343, p < 0.001). Additionally, dexmedetomidine demonstrated protective effects against postoperative anxiety symptoms, sleep disturbance, and delirium. In age, gender, cumulative comorbidity, frailty, ASA physical status, and inhaled anesthetic subgroups, we also found that dexmedetomidine was associated with a reduction in postoperative depressive symptoms in older noncardiac patients.
Intraoperative dexmedetomidine administration was associated with a reduction in postoperative 7-day depressive symptoms, anxiety symptoms, sleep disturbances, and delirium in older patients undergoing noncardiac surgery.
The clinical trial protocol of this study was registered in the Clinical Trial registry (NCT06362408).
The authors have nothing to report.
神经精神症状显著影响手术恢复、生活质量和长期生存。旨在研究非心脏手术患者术中给予右美托咪定与术后抑郁症状发生率之间的关联。
对2020年4月至2022年4月期间65岁以上的老年手术患者进行一项多中心前瞻性观察研究。主要结局是术后7天抑郁症状的发生率。次要结局是术后7天焦虑症状、睡眠障碍和谵妄的发生率。采用基于随机效应的逻辑回归模型来确定右美托咪定给药与结局之间的关联。倾向评分匹配（PSM）和逆概率处理加权（IPTW）用于解决数据不平衡问题。进行基于特定人群的亚组分析以探讨右美托咪定与抑郁症状之间的关系。
在5591例患者中，20.5%（1148例）接受了术中右美托咪定。与未使用右美托咪定的组相比，右美托咪定组术后7天抑郁症状的发生率显著更低（未调整：7.6%对26.7%，p<0.001；PSM：7.9%对29.0%，IPTW：8.7%对25.8%，p<0.001）。右美托咪定与术后7天抑郁症状的缓解显著相关（调整后的随机效应模型：风险比[RR]0.104，95%置信区间，0.080 - 0.140，p<0.001；PSM：RR 0.311，95%置信区间，0.242 - 0.415，p<0.001；IPTW：RR 0.297，95%置信区间，0.253 - 0.343，p<0.001）。此外，右美托咪定对术后焦虑症状、睡眠障碍和谵妄具有保护作用。在年龄、性别、累积合并症、虚弱程度、美国麻醉医师协会（ASA）身体状况和吸入麻醉亚组中，我们还发现右美托咪定与老年非心脏手术患者术后抑郁症状的减少有关。
在接受非心脏手术的老年患者中，术中给予右美托咪定与术后7天抑郁症状、焦虑症状、睡眠障碍和谵妄的减少有关。
本研究的临床试验方案已在临床试验注册中心注册（NCT06362408）。
作者无相关报告。
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