右美托咪定对老年患者术后认知功能的影响的系统评价

doi:10.3969/j.issn.1009-976X.2014.05.013

摘要/Abstract

摘要：

目的系统评价右美托咪定（dexmedetomidine，DEX）对老年患者术后认知功能的影响，为老年患者术后认知功能障碍的防治提供依据。方法计算机检索Pubmed、Cochrane Library、CNKI和万方等数据库，手工检索图书馆馆藏期刊，检索时限截至2014年4月。按照纳入和排除标标准收集DEX对老年患者术后认知功能的影响的随机对照试验（RCT），按照改良Jadad 质量评估量表评价纳入研究的方法学质量，采用STATE 12.0软件进行Meta分析。结果共纳入19个RCT，1202例患者。与对照组相比，DEX组术后第1天及第7天的简易精神状态检查量表评分较高，且术后第1天及第7天认知功能障碍发生率也明显减少。结论 DEX可改善老年患者术后认知功能，对减轻老年患者术后认知功能障碍有一定的防治疗效。

关键词: 右美托咪定, 认知功能, 老年患者, 系统评价, Meta分析

Abstract: 【Abstract】〓Objective〓To systematically evaluate the effect of dexmedetomidine on the incidence of early postoperative cognitive function in elderly patients undergoing noncardiac surgeries,so as to provide evidence for prevention and treatment of postoperative cognitive dysfunction (POCD) in elderly patients. Methods〓Databases including the Cochrane Library, PubMed, CNKI, and WanFang Data (by April 2014) were searched for randomized controlled trials (RCTs) on effect of dexmedetomidine on early postoperative cognitive function in elderly patients undergoing noncardiac surgeries. According to the modified Jadad quality scale, literature was screened, data were extracted, and quality of the included studies was critically evaluated. The meta-analysis was performed using STATE 12.0 software. Results〓A total of 19 RCTs involving 1202 patients were included. The results of meta-analyses showed that: compared with the control group, the scores on the Minimum Mental State Examination (MMSE)at the 1st and the 7th day after surgery were significantly higher in the dexmedetomidine group,and the ratio of early POCD incidence at the 1st and the seventh day after surgery in the dexmedetomidine group were significantly lower than those in the control group. Conclusion Dexmedetomidine might benefit postoperative cognitive function and might be effective for ameliorating POCD in elderly patients.

Key words: Dexmedetomidine, Cognitive function, Elderly patients, Meta-analysis

中图分类号:

R614

陈伟强郑春勤黄盛鑫曹铭辉. 右美托咪定对老年患者术后认知功能的影响的系统评价[J]. 岭南现代临床外科, 2014, 14(05): 543-549.

Chen Weiqiang, Zheng Chunqin, Huang Shengxing, Cao Minghui. Effect of dexmedetomidine on postoperative cognitive function of elderly patients: a systematic review[J]. Lingnan Modern Clinics in Surgery, 2014, 14(05): 543-549.

参考文献

[1] Damuleviciene G, Lesauskaite V, Macijauskiene J. [Postoperative cognitive dysfunction of older surgical patients] [J]. Medicina (Kaunas), 2010, 46(3): 169-175.
[2] Silbert B, Evered L, Scott DA. Cognitive decline in the elderly: is anaesthesia implicated? [J]. Best Pract Res Clin Anaesthesiol, 2011, 25(3): 379-393.
[3] Cosar M, Eser O, Fidan H, et al. The neuroprotective effect of dexmedetomidine in the hippocampus of rabbits after subarachnoid hemorrhage [J]. Surg Neurol, 2009, 71(1): 54-59; discussion 59.
[4] Chen J, Yan J, Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients [J]. Exp Ther Med, 2013, 5(2): 489-494.
[5] 史曼, 右美托咪定对术后早期认知功能的影响. 2011, 昆明医学院.
[6] 陈红, 张希. 右美托咪定对老年患者腹腔镜胆囊切除术后认知功能的影响 [J]. 中国老年学杂志, 2012, 32(22): 5050-5051.
[7] 陈力, 李传翔, 宋伏虎, et al. 右美托咪定对老年人全髋置换术后早期认知功能障碍的影响 [J]. 广东医学, 2012, 33(21): 3321-3323.
[8] 方梅, 黄小冬, 禚海成, et al. 右美托咪定对老年髋关节手术患者早期认知功能和炎症因子的影响 [J]. 放射免疫学杂志, 2012, 25(5): 548-551.
[9] 李平, 王卫萍, 王云环. 右美托咪定对老年患者腹腔镜胆囊切除术后认知功能的影响 [J]. 吉林医学, 2012, 33(33): 7253.
[10] 罗艳萍, 方敏, 邬子林. 右美托咪啶对老年患者全麻术后早期认知功能的影响 [J]. 中国中西医结合外科杂志, 2012(6): 568-571.
[11] 莫坚, 莫桂熙, 刘亦君, et al. 盐酸右美托咪定对老年腹部手术患者术后认知功能障碍的影响 [J]. 实用医学杂志, 2012, 28(24): 4150-4152.
[12] 钱玉芳. 右美托咪定对老年患者术后早期认知功能的影响 [J]. 中国基层医药, 2012, 19(9): 1379-1380.
[13] 孙杨, 术前应用盐酸右美托咪定对全麻患者影响的临床研究. 2012, 南昌大学.
[14] 余潇, 右美托咪定在老年患者结直肠癌根治术中的临床应用及其对术后认知功能的影响. 2012, 山东大学.
[15] 张奕文, 何忠承, 石世坚, et al. 右美托咪定复合七氟烷全麻对老年患者术后早期认知功能的影响 [J]. 广东医学, 2012, 33(14): 2172-2174.
[16] 钟学武. 右美托咪定对老年患者髋关节置换术后认知功能障碍的影响 [J]. 海峡药学, 2012, 24(5): 109-111.
[17] 柯剑娟, 张宗泽, 冯晓波, et al. 不同剂量右美托咪定预防腹腔热灌注化疗老年患者术后认知功能障碍的效果 [J]. 中华麻醉学杂志, 2013, 33(10): 1192-1194.
[18] 廉箫, 右美托咪定对老年患者腹腔镜胆囊切除术后早期认知功能的影响. 2013, 新疆医科大学.
[19] 孙章楠, 右美托咪定对老年患者腹部手术术后认知功能的影响. 2013, 河北医科大学.
[20] 王育明. 盐酸右美托咪定对老年乳腺癌患者术后认知功能的影响 [J]. 中国老年学杂志, 2013, 33(13): 3167-3168.
[21] 魏兵华, 李长科, 徐明清, et al. 盐酸右美托咪定对老年胃肠手术后患者早期认知功能的影响 [J]. 中国医师杂志, 2013, 15(5): 660-662.
[22] 朱虹燕, 右美托咪定对老年患者术后认知功能及炎症因子的影响. 2013, 吉林大学.
[23] 李民, 张利萍, 吴新民. 右美托咪啶在临床麻醉中应用的研究进展 [J]. 中国临床药理学杂志, 2007, 23(6): 466-470.
[24] Rasmussen LS, O'Brien JT, Silverstein JH, et al. Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? [J]. Acta Anaesthesiol Scand, 2005, 49(9): 1225-1231.
[25] 徐伟民, 刘国庆. 盐酸右美托咪定超前镇静对腹腔镜胆囊切除术老年患者应激反应的影响 [J]. 中国老年学杂志, 2013, 33(2): 309-312.
[26] Kawasaki T, Kawasaki C, Ueki M, et al. Dexmedetomidine suppresses proinflammatory mediator production in human whole blood in vitro [J]. J Trauma Acute Care Surg, 2013, 74(5): 1370-1375.