Mohammadipour Anvari Hassan, Shiri Hossein, Charsouei Saeid, Ashrafi Nima, Rezaei Mansour
Department of Anesthesiology and Operating Room, Tabriz University of Medical Sciences Tabriz, Iran.
Tabriz University of Medical Sciences Tabriz, Iran.
Med J Islam Repub Iran. 2025 Feb 3;39:19. doi: 10.47176/mjiri.39.19. eCollection 2025.
Delirium is a significant issue for esophagectomy patients, with dexmedetomidine (Dex) showing promise in alleviating this burden. A randomized trial on Dex's role in post-esophagectomy delirium can enhance care strategies and patient outcomes.
This randomized, double-blind clinical trial, conducted at Imam Reza Hospital, Tabriz University of Medical Sciences, in Iran in 2022, involved 60 esophagectomy patients. The intervention group received Dex infusion (0.5 μg/kg/h), while the control group received normal saline. Postoperatively, patients received analgesia and were monitored for delirium incidence over 3 days in the intensive care unit (ICU) using the Confusion Assessment Method. This study utilized an independent-sample t test, the Mann-Whitney U test, the χ2 test, and the Kaplan-Meier survival analysis with a log-rank test for data comparisons.
Delirium in the ICU over 3 days after surgery was significantly lower in the intervention group (10%, n=3) compared with the control group (20%, n=6) (relative risk, 0.62 [95% CI, 0.42-0.98]; =0.036). On the first day, no delirium cases occurred in the intervention group, contrasting with 2 cases in the control group (=0.014). Similarly, on the second day, one case was observed in the intervention group versus 2 in the control group (=0.042). On the third day, 2 cases were recorded in the intervention group versus 3 in the control group (=0.031).
The significant reduction in delirium occurrence observed in patients receiving intraoperative Dex infusion highlights its potential as a preventive strategy for postoperative delirium in ICU patients after esophagectomy.
谵妄是食管切除术患者面临的一个重要问题，右美托咪定（Dex）在减轻这一负担方面显示出前景。一项关于Dex在食管切除术后谵妄中作用的随机试验可以改善护理策略和患者预后。
这项随机、双盲临床试验于2022年在伊朗大不里士医科大学伊玛目礼萨医院进行，纳入了60例食管切除术患者。干预组接受Dex输注（0.5μg/kg/h），而对照组接受生理盐水。术后，患者接受镇痛治疗，并在重症监护病房（ICU）使用意识模糊评估法监测3天内的谵妄发生率。本研究采用独立样本t检验、曼-惠特尼U检验、χ2检验以及带有对数秩检验的Kaplan-Meier生存分析进行数据比较。
干预组术后3天在ICU发生谵妄的情况（10%，n = 3）显著低于对照组（20%，n = 6）（相对风险，0.62 [95% CI，0.42 - 0.98]；P = 0.036）。第一天，干预组未发生谵妄病例，而对照组有2例（P = 0.014）。同样，第二天，干预组观察到1例，对照组为2例（P = 0.042）。第三天，干预组记录到2例，对照组为3例（P = 0.031）。
术中接受Dex输注的患者谵妄发生率显著降低，这突出了其作为食管切除术后ICU患者术后谵妄预防策略的潜力。
