【原】【罂粟摘要】在拟行心脏手术的患者中输注右美托咪定过夜以预防术后谵妄：一项实用、随机、双盲、安慰剂对照试验

在拟行心脏手术的患者中输注右美托咪定过夜以预防术后谵妄：一项实用、随机、双盲、安慰剂对照试验

贵州医科大学              麻醉与心脏电生理课题组

翻译：宋雨婷         编辑：田明德    审校：曹莹

背景：术后谵妄（PoD）对心脏手术患者预后有显著的负面影响。迄今为止，尚无针对PoD有价值和特异性的治疗方法。危重病人往往睡眠状况不佳。谵妄与心脏手术后的睡眠质量有关。本研究旨在确定输注右美托咪定过夜以促进睡眠是否能降低心脏手术术后谵妄的发生率。

方法：2019年1月至2021年7月的随机、实用、多中心、双盲、安慰剂对照试验。将年纪≥65岁拟行择期心脏手术的患者按1：1的比例随机分为右美托咪定组和安慰剂组。患者在ICU期间，从术后晚上8时至早上8时输注右美托咪定或安慰剂，最多给药时间为7天。主要结局指标为术后7天内术后谵妄（PoD）的发生率。

结果：共有348名患者签署知情同意书，其中333名进行随机分配：331名患者接受了手术并进行分析（165名患者接受右美托咪定，166名患者接受安慰剂）。两组患者PoD的发生率无统计学意义（12.6%比12.4%，P = 0.97）。右美托咪定组低血压发生率较高（7.3%比0.6%；P< 0.01）。术后3个月，两组间功能结局（健康调查量表36，认知失败问卷，PCL-5）具有可比性。

 

 

结论：择期心脏手术患者恢复过程中，过夜输注右美托咪定不能减少术后谵妄。

原始文献来源：

Huet O, Gargadennec T, Oilleau JF, et al. Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial. Crit Care. 2024;28(1):64. Published 2024 Feb 29.

Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial

Background: After cardiac surgery, post-operative delirium (PoD) is acknowledged to have a significant negative impact on patient outcome. To date, there is no valuable and specific treatment for PoD. Critically ill patients often suffer from poor sleep condition. There is an association between delirium and sleep quality after cardiac surgery. This study aimed to establish whether promoting sleep using an overnight infusion of dexmedetomidine reduces the incidence of delirium after cardiac surgery.

Methods: Randomized, pragmatic, multicentre, double-blind, placebo controlled trial from January 2019 to July 2021. All adult patients aged 65 years or older requiring elective cardiac surgery were randomly assigned 1:1 either to the dexmedetomidine group or the placebo group on the day of surgery. Dexmedetomidine or matched placebo infusion was started the night after surgery from 8 pm to 8 am and administered every night while the patient remained in ICU, or for a maximum of 7 days. Primary outcome was the occurrence of postoperative delirium (PoD) within the 7 days after surgery.

Results: A total of 348 patients provided informed consent, of whom 333 were randomized: 331 patients underwent surgery and were analysed (165 assigned to dexmedetomidine and 166 assigned to placebo). The incidence of PoD was not significantly different between the two groups (12.6% vs. 12.4%, p = 0.97). Patients treated with dexmedetomidine had significantly more hypotensive events (7.3% vs 0.6%; p < 0.01). At 3 months, functional outcomes (Short-form 36, Cognitive failure questionnaire, PCL-5) were comparable between the two groups.

Conclusion: In patients recovering from an elective cardiac surgery, an overnight infusion of dexmedetomidine did not decrease postoperative delirium.