术中应用右美托咪定预防术后老年非心脏手术患者谵妄：随机临床试验
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Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery
背景与目的
老年患者术后常发生谵妄，预后差。本研究旨在探讨术中应用右美托咪定对老年大手术患者谵妄发生率的影响。
方 法
这是一项随机、双盲、安慰剂对照试验。将计划进行大型非心脏手术的老年患者(60岁以上)随机分为两组。治疗组在麻醉诱导前10min给予负荷量右美托咪啶0.6ug/kg，然后持续输注(0.5ug/kg/h)至手术结束前1h。对照组患者在相同的时间内接受相同剂量的生理盐水。主要评估指标是术后前5天内的谵妄发生率。采用混合评估法(CAM)对非机械通气患者和重症监护病房机械通气患者进行谵妄评估。
结 果
共纳入309例接受右美托咪定治疗的患者和310例对照组患者进行意向治疗分析。右美托咪啶治疗组术后5d内谵妄发生率较低：治疗组5%(17/309)，低于对照组10%(32/310)。右美托咪定治疗组术后30天并发症的总发生率也较低，治疗组(309人中的60人)占19.4%，对照组(310人中的81人)占26.1%（RR 0.74, 0⋅55 to 0.99, P = 0⋅047）。
结 论
术中使用右美托咪啶可使老年人在非心脏大手术后发生谵妄的风险减半。
原始文献摘要
Li CJ,Wang BJ,Mu DL.Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery.Br J Surg 2020,107(2).
Background: Delirium is common in elderly patients after surgery and is associated with poor outcomes.This study aimed to investigate the impact of intraoperative dexmedetomidine on the incidence of delirium in elderly patients undergoing major surgery.
Methods: This was a randomized double-blind placebo-controlled trial. Elderly patients (aged 60 years or more) scheduled to undergo major non-cardiac surgery were randomized into two groups. Patients in the intervention group received a loading dose of dexmedetomidine 0⋅6 ug/kg 10 min before induction of anaesthesia followed by a continuous infusion (0⋅5 ug per kg per h) until 1 h before the end of surgery.Patients in the control group received volume-matched normal saline in the same schedule. The primary outcome was the incidence of delirium during the first 5 days after surgery. Delirium was assessed with the Confusion Assessment Method (CAM) for non-ventilated patients and CAM for the Intensive Care Unit for ventilated patients.
Results: In total, 309 patients who received dexmedetomidine and 310 control patients were included in the intention-to-treat analysis. The incidence of delirium within 5 days of surgery was lower with dexmedetomidine treatment: 5⋅5 per cent (17 of 309) versus 10⋅3 per cent (32 of 310) in the control group(relative risk (RR) 0⋅53, 95 per cent c.i. 0⋅30 to 0⋅94; P = 0⋅026). The overall incidence of complications at 30 days was also lower after dexmedetomidine (19⋅4 per cent (60 of 309) versus 26⋅1 per cent (81 of 310)for controls; RR 0⋅74, 0⋅55 to 0⋅99, P = 0⋅047).
Conclusion: Intraoperative dexmedetomidine halved the risk of delirium in the elderly after major non-cardiac surgery.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：唐剑 编辑：冯玉蓉 审校：王贵龙