Influence of Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Patients after Receiving Noncardiac Surgery under General Anesthesia: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 HUOQi-fan , WANGLi-mei ,  LVHuang-wei

Department of Anesthesiology, First Affiliated Hospital, China Medical University, Shenyang 110001, China;

Corresponding?author：

LVHuang-wei, Email: hwl1998@yahoo.com

Keywords：

Dexmedetomidine; General anesthesia; Noncardiac surgery; Cognitive function; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140198

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction in adult patients after receiving noncardiac surgery under general anesthesia. Methods The randomized controlled trials (RCTs) about the influence of dexmedetomidine on the early postoperative cognitive dysfunction of patients after receiving noncardiac surgery with general anesthesia was searched in PubMed, EBSCO, Springer, Ovid, The Cochrane Library (Issue 1, 2013), CNKI, VIP, WanFang Data and Google Scholar up to November 30^th, 2013. The references of included literature were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results A total of 22 RCTs involving 1 356 patients were enrolled. The results of meta-analysis indicated that:a) dexmedetomidine reduced the incidence of postoperative cognitive dysfunction on the first day (RR=0.38, 95%CI 0.29 to 0.49, P < 0.001), on the seventh day (RR=0.55, 95%CI 0.23 to 1.29, P=0.17); improved postoperative MMSE scores after surgery (on the first day:MD=2.38, 95%CI 1.42 to 3.34, P < 0.001; on the seventh day:MD=0.92, 95%CI 0.16 to 1.68, P=0.02), and decreased the expression of inflammatory factor IL-6 (instant:MD=-11.96, 95%CI-18.45 to-5.46, P=0.000 3; after 24 h:MD=-7.50, 95%CI-13.73 to-1.27, P=0.02); and TNF-α (instant:MD=-4.09, 95%CI-7.02 to-1.16, P=0.006)) in patients. b) No significant difference was found between two groups (MD=-0.97, 95%CI-2.37 to 0.43, P=0.17). Conclusion Dexmedetomidine can effectively reduce the early-stage postoperative cognitive dysfunction, improve MMSE scores after the operation, and reduce inflammatory reaction. In addition, due to the limited quantity and quality of studies included, larger sample, high quality RCTs are needed to verify the abovementioned conclusion.

Citation： HUOQi-fan, WANGLi-mei, LVHuang-wei. Influence of Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Patients after Receiving Noncardiac Surgery under General Anesthesia: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(10): 1225-1233. doi: 10.7507/1672-2531.20140198 Copy

1.	李琪, 江偉.術后認知功能障礙研究進展.醫學綜述, 2010, 16(2):231-234.
2.	Ma D, Rajakumaraswamy N, Maze M. Alpha2-Adrenoceptor agonists:shedding light on neuroprotection. Br Med Bull, 2005, 71(1):77-92.
3.	趙冰潔, 劉洋, 李仔楠, 等.右旋美托咪啶在圍術期的應用進展.中國保健營養(下旬刊), 2013, 23(1):491.
4.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0).[cited 2012 Jan 5]. Available at:http://www.cochrane-handbook.org.
5.	莫堅, 莫桂熙, 劉亦君, 等.鹽酸右美托咪定對老年腹部手術患者術后認知功能障礙的影響.實用醫學雜志, 2012, 28(24):4150-4152.
6.	陳紅, 張希.右美托咪定對老年患者腹腔鏡膽囊切除術后認知功能的影響.中國老年學雜志, 2012, 32(22):5050-5051.
7.	陳靖軍, 張三虎, 李克寒, 等.鹽酸右美托咪定對老年結腸癌患者術后認知功能的影響.中國實用醫藥, 2012, 7(6):171-172.
8.	陳力, 李傳翔, 宋伏虎, 等.右美托咪定對老年人全髖置換術后早期認知功能障礙的影響.廣東醫學, 2012, 33(21):3321-3323.
9.	全承炫, 歐陽文.右旋美托咪定在老年患者腰椎手術中的臨床應用及其對術后認知功能的影響.長沙:中南大學, 2011.
10.	項余華, 葉月利, 羅蘋, 等.右美托咪啶對老年人術后認知功能的影響.中國中西醫結合外科雜志, 2012, 18(4):358-360.
11.	幸志強, 陶明哲.右美托咪啶對老年患者術后認知功能的影響.現代醫院, 2012, 12(2):18-19.
12.	余瀟, 張孟元.右美托咪定在老年患者結直腸癌根治術中的臨床應用及其對術后認知功能的影響.濟南:山東大學, 2012.
13.	羅艷萍, 方敏, 鄔子林.右美托咪啶對老年患者全麻術后早期認知功能的影響.中國中西醫結合外科雜志, 2012, 18(6):568-571.
14.	呂安慶, 陳文迪.右美托咪定聯合全麻下老年患者術后認知功能與腦氧代謝的關系.河北醫科大學學報, 2012, 33(3):299-301.
15.	張偉, 張加強, 孟凡民.不同劑量右美托咪定麻醉對食管癌根治術患者術后認知功能的影響.山東醫藥, 2013, 53(7):15-18.
16.	張奕文, 何忠承, 石世堅, 等.右美托咪定復合七氟烷全麻對老年患者術后早期認知功能的影響.廣東醫學, 2012, 33(14):2172-2174.
17.	李愛梅, 石翊颯, 高瑞萍, 等.不同劑量右美托咪定對腦膜瘤切除術患者術后認知功能的影響.臨床麻醉學雜志, 2013, 29(7):665-668.
18.	李麗妍, 黃金平, 劉樺, 等.右美托咪定對老年患者髖關節置換術后認知功能的影響.廣東醫學, 2013, 34(5):781-783.
19.	李平, 王衛萍, 王云環.右美托咪定對老年患者腹腔鏡膽囊切除術后認知功能的影響.吉林醫學, 2012, 33(33):7253-7253.
20.	劉曉華.右美托咪啶對腹腔鏡下直腸癌根治術后早期認知功能障礙的影響.實用癌癥雜志, 2013, 28(5):527-529.
21.	石雙平, 王薇, 胡柳生, 等.右美托咪啶對老年患者非心臟手術后早期認知功能的影響.醫學臨床研究, 2012, 29(12):2289-2291.
22.	孫章楠, 董振明.右美托咪定對老年患者腹部手術術后認知功能的影響.石家莊:河北醫科大學, 2013.
23.	王育明.鹽酸右美托咪定對老年乳腺癌患者術后認知功能的影響.中國老年學雜志, 2013, 33(13):3167-3168.
24.	薛曉英, 何海燕, 譚秀娟, 等.右美托咪啶對老年患者腹腔鏡膽囊切除術術后認知功能的影響.中國當代醫藥, 2013, 20(17):105-106.
25.	朱虹燕, 周春燕.右美托咪定對老年患者術后認知功能及炎癥因子的影響.長春:吉林醫科大學, 2013.
26.	Chen J, Yan J, Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp The Med, 2013, 5(2):489-494.
27.	Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists their pharmacology and therapeutic role. Anaesthesia, 1999, 54(2):146-165.
28.	王麗美, 常小麗, 任許利, 等.心臟手術后右美托咪定鎮靜效果的Meta分析.中國循證醫學雜志, 2013, 13(1):93-99.
29.	卓帥, 鄭劍橋, 劉斌.右美托咪啶和丙泊酚對術后ICU患者鎮靜效果的系統評價.中國循證醫學雜志, 2012, 12(6):686-693.
30.	裴皓.鹽酸右美托咪定的藥理作用與臨床應用.醫藥導報, 2010, 29(12):1603-1607.
31.	李民, 張利萍, 吳新民.右美托咪啶在臨床麻醉中應用的研究進展.中國臨床藥理學雜志, 2007, 23(6):466-470.
32.	李靜.老年患者非心臟術后認知功能障礙.醫學綜述, 2009, 15(20):3107-3109.
33.	Rasmussen LS. Defining postoperative cognitive dysfunction. Eur J Anaesth, 1998, 15(6):761-764.
34.	李穎川, 安一凡, 董維華, 等.老年患者全髖關節置換術后認知功能障礙與圍術期炎性反應的相關性.上海醫學, 2011, 34(4):249-252.
35.	郭浩翔, 金立民, 崔常雷, 等.炎癥對老年患者術后認知功能障礙影響的研究進展.中國老年學雜志, 2012, 32(22):5081-5083.
36.	Taniguchi T, Kidani Y, Kanakura H, et al. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin-induced shock in rats. Crit Care Med, 2004, 32(6):1322-1326.
37.	Hofer S, Steppan J, Wagner T, et al. Central sympatholytics prolong survival in experimental sepsis. Critical care[serial online]. 2008 Nov-2009 Feb[cited 2009 Feb 6], 13(1):[24 screen]. Available at:http://ccforum.Com/content/13/1/R11.
38.	Tasdogan M, Memis D, Sut N, et al. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J Clin Anesth, 2009, 21(6):394-400.
39.	Sezer A, Memis D, Usta U, et al. The effect of dexmedetomidine on liver histopathology in a rat sepsis model:an experimental pilot study. Ulus Travma Acil Cer, 2010, 16(2):108-112.
40.	劉海林, 錢燕寧.右美托咪定對心臟瓣膜置換術患者圍術期炎性反應的影響.中國應用生理學雜志, 2013, 29(4):316-317.
41.	施彩鳳, 張林, 陳思佳, 等.右旋美托咪啶在全麻誘導中對腦電雙頻譜及血流動力學指數的影響.青島大學醫學院學報, 2012, 48(01):59-61.

1. 李琪, 江偉.術后認知功能障礙研究進展.醫學綜述, 2010, 16(2):231-234.
2. Ma D, Rajakumaraswamy N, Maze M. Alpha2-Adrenoceptor agonists:shedding light on neuroprotection. Br Med Bull, 2005, 71(1):77-92.
3. 趙冰潔, 劉洋, 李仔楠, 等.右旋美托咪啶在圍術期的應用進展.中國保健營養(下旬刊), 2013, 23(1):491.
4. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0).[cited 2012 Jan 5]. Available at:http://www.cochrane-handbook.org.
5. 莫堅, 莫桂熙, 劉亦君, 等.鹽酸右美托咪定對老年腹部手術患者術后認知功能障礙的影響.實用醫學雜志, 2012, 28(24):4150-4152.
6. 陳紅, 張希.右美托咪定對老年患者腹腔鏡膽囊切除術后認知功能的影響.中國老年學雜志, 2012, 32(22):5050-5051.
7. 陳靖軍, 張三虎, 李克寒, 等.鹽酸右美托咪定對老年結腸癌患者術后認知功能的影響.中國實用醫藥, 2012, 7(6):171-172.
8. 陳力, 李傳翔, 宋伏虎, 等.右美托咪定對老年人全髖置換術后早期認知功能障礙的影響.廣東醫學, 2012, 33(21):3321-3323.
9. 全承炫, 歐陽文.右旋美托咪定在老年患者腰椎手術中的臨床應用及其對術后認知功能的影響.長沙:中南大學, 2011.
10. 項余華, 葉月利, 羅蘋, 等.右美托咪啶對老年人術后認知功能的影響.中國中西醫結合外科雜志, 2012, 18(4):358-360.
11. 幸志強, 陶明哲.右美托咪啶對老年患者術后認知功能的影響.現代醫院, 2012, 12(2):18-19.
12. 余瀟, 張孟元.右美托咪定在老年患者結直腸癌根治術中的臨床應用及其對術后認知功能的影響.濟南:山東大學, 2012.
13. 羅艷萍, 方敏, 鄔子林.右美托咪啶對老年患者全麻術后早期認知功能的影響.中國中西醫結合外科雜志, 2012, 18(6):568-571.
14. 呂安慶, 陳文迪.右美托咪定聯合全麻下老年患者術后認知功能與腦氧代謝的關系.河北醫科大學學報, 2012, 33(3):299-301.
15. 張偉, 張加強, 孟凡民.不同劑量右美托咪定麻醉對食管癌根治術患者術后認知功能的影響.山東醫藥, 2013, 53(7):15-18.
16. 張奕文, 何忠承, 石世堅, 等.右美托咪定復合七氟烷全麻對老年患者術后早期認知功能的影響.廣東醫學, 2012, 33(14):2172-2174.
17. 李愛梅, 石翊颯, 高瑞萍, 等.不同劑量右美托咪定對腦膜瘤切除術患者術后認知功能的影響.臨床麻醉學雜志, 2013, 29(7):665-668.
18. 李麗妍, 黃金平, 劉樺, 等.右美托咪定對老年患者髖關節置換術后認知功能的影響.廣東醫學, 2013, 34(5):781-783.
19. 李平, 王衛萍, 王云環.右美托咪定對老年患者腹腔鏡膽囊切除術后認知功能的影響.吉林醫學, 2012, 33(33):7253-7253.
20. 劉曉華.右美托咪啶對腹腔鏡下直腸癌根治術后早期認知功能障礙的影響.實用癌癥雜志, 2013, 28(5):527-529.
21. 石雙平, 王薇, 胡柳生, 等.右美托咪啶對老年患者非心臟手術后早期認知功能的影響.醫學臨床研究, 2012, 29(12):2289-2291.
22. 孫章楠, 董振明.右美托咪定對老年患者腹部手術術后認知功能的影響.石家莊:河北醫科大學, 2013.
23. 王育明.鹽酸右美托咪定對老年乳腺癌患者術后認知功能的影響.中國老年學雜志, 2013, 33(13):3167-3168.
24. 薛曉英, 何海燕, 譚秀娟, 等.右美托咪啶對老年患者腹腔鏡膽囊切除術術后認知功能的影響.中國當代醫藥, 2013, 20(17):105-106.
25. 朱虹燕, 周春燕.右美托咪定對老年患者術后認知功能及炎癥因子的影響.長春:吉林醫科大學, 2013.
26. Chen J, Yan J, Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp The Med, 2013, 5(2):489-494.
27. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists their pharmacology and therapeutic role. Anaesthesia, 1999, 54(2):146-165.
28. 王麗美, 常小麗, 任許利, 等.心臟手術后右美托咪定鎮靜效果的Meta分析.中國循證醫學雜志, 2013, 13(1):93-99.
29. 卓帥, 鄭劍橋, 劉斌.右美托咪啶和丙泊酚對術后ICU患者鎮靜效果的系統評價.中國循證醫學雜志, 2012, 12(6):686-693.
30. 裴皓.鹽酸右美托咪定的藥理作用與臨床應用.醫藥導報, 2010, 29(12):1603-1607.
31. 李民, 張利萍, 吳新民.右美托咪啶在臨床麻醉中應用的研究進展.中國臨床藥理學雜志, 2007, 23(6):466-470.
32. 李靜.老年患者非心臟術后認知功能障礙.醫學綜述, 2009, 15(20):3107-3109.
33. Rasmussen LS. Defining postoperative cognitive dysfunction. Eur J Anaesth, 1998, 15(6):761-764.
34. 李穎川, 安一凡, 董維華, 等.老年患者全髖關節置換術后認知功能障礙與圍術期炎性反應的相關性.上海醫學, 2011, 34(4):249-252.
35. 郭浩翔, 金立民, 崔常雷, 等.炎癥對老年患者術后認知功能障礙影響的研究進展.中國老年學雜志, 2012, 32(22):5081-5083.
36. Taniguchi T, Kidani Y, Kanakura H, et al. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin-induced shock in rats. Crit Care Med, 2004, 32(6):1322-1326.
37. Hofer S, Steppan J, Wagner T, et al. Central sympatholytics prolong survival in experimental sepsis. Critical care[serial online]. 2008 Nov-2009 Feb[cited 2009 Feb 6], 13(1):[24 screen]. Available at:http://ccforum.Com/content/13/1/R11.
38. Tasdogan M, Memis D, Sut N, et al. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J Clin Anesth, 2009, 21(6):394-400.
39. Sezer A, Memis D, Usta U, et al. The effect of dexmedetomidine on liver histopathology in a rat sepsis model:an experimental pilot study. Ulus Travma Acil Cer, 2010, 16(2):108-112.
40. 劉海林, 錢燕寧.右美托咪定對心臟瓣膜置換術患者圍術期炎性反應的影響.中國應用生理學雜志, 2013, 29(4):316-317.
41. 施彩鳳, 張林, 陳思佳, 等.右旋美托咪啶在全麻誘導中對腦電雙頻譜及血流動力學指數的影響.青島大學醫學院學報, 2012, 48(01):59-61.

Chinese Journal of Evidence-Based Medicine

Influence of Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Patients after Receiving Noncardiac Surgery under General Anesthesia: A Meta-Analysis

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