Influence of dexmedetomidine on early postoperative cognitive dysfunction and inflammatory factors in elderly patients: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

TANG Yaxing , HE Lili , LIU Ling ,  TANG Xiaoning

Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding?author：

TANG Xiaoning, Email: 1419868567@qq.com

Keywords：

Dexmedetomidine; Inflammatory factors; Elderly patients; Postoperative cognitive dysfunction; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201707090

Video：

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Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and serum inflammatory factors in elderly patients.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases from inception to April 2017, to collect randomized controlled trials (RCTs) about dexmedetomidine for early POCD in elderly patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 RCTs, including 2 026 patients were enrolled. The results of meta-analysis showed that, the incidence of POCD in the dexmedetomidine group was lower than that in the control group (the first day: RR=0.40, 95%CI 0.30 to 0.53, P<0.000 01; the third day: RR=0.33, 95%CI 0.23 to 0.48,P<0.000 01; the seventh day: RR=0.42, 95%CI 0.22 to 0.78,P=0.006). Meanwhile, compared with the control group, the dexmedetomidine group significantly decreased the serum levels of TNF-α (immediately after operation: MD=–5.43, 95%CI –7.44 to –3.42, P<0.000 01; 1 h after operation: MD=–4.64, 95%CI –6.92 to –2.36,P<0.000 1; 24 h after operation: MD=–3.27, 95%CI –4.92 to –1.63,P<0.000 1) and IL-6 (immediately after operation: MD=–30.69, 95%CI –41.39 to –20.00,P<0.000 01; 1h after operation: MD=–20.84, 95%CI –28.87 to –12.80,P<0.000 01; 24 h after operation: MD=–13.42, 95%CI –19.90 to –6.94,P<0.000 1).ConclusionCurrent evidence indicates that dexmedetomidine could relief early POCD in elderly patients, in which the reduction of serum inflammatory factors alleviate inflammation response may play a vital role. Due to the limited quality and quantity of included studies, more high quality RCTs are required to verify the above conclusion.

Citation： TANG Yaxing, HE Lili, LIU Ling, TANG Xiaoning. Influence of dexmedetomidine on early postoperative cognitive dysfunction and inflammatory factors in elderly patients: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(3): 351-362. doi: 10.7507/1672-2531.201707090 Copy

1.	Deiner S, Silverstein J. Postoperative delirium and cognitive dysfunction. Br J Anaesth, 2009, 103(suppl 1): i41-i46.
2.	Moller J, Cluitmans P, Rasmussen L, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet, 1998, 351(9106): 857-861.
3.	闞敏慧, 肖瑋, 王天龍. 老年人中樞炎癥反應與認知功能障礙的相關性研究進展. 國際麻醉學與復蘇雜志, 2016, 37(8): 718-722.
4.	Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). Available at: 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.	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.
7.	葉壯. 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. 中外醫療, 2014, 33(7): 102-103.
8.	付繼軍. 右美托咪定對老年髖關節置換術患者早期認知功能及 IL-1、IL-6、TNF-α 的影響. 中國醫藥指南, 2014, 12(27): 153-155.
9.	孟海兵, 來偉, 帥君, 等. 右美托咪定對老年患者全麻術后認知功能及炎癥因子的影響. 實用醫學雜志, 2014, 30(14): 2300-2301.
10.	丁玲玲, 張宏, 米衛東, 等. 右美托咪定對老年患者在機器人輔助腹腔鏡手術麻醉蘇醒期及術后認知功能的影響. 中南大學學報 (醫學版), 2015, 40(2): 129-135.
11.	曹福羊, 馬麗, 李娟, 等. 右美托咪定輔助全身麻醉對老年結直腸癌患者術后早期認知功能的影響. 山東醫藥, 2015, 55(40): 76-78.
12.	鈔海蓮, 趙莉, 李榮, 等. 右美托咪定對腹腔鏡膽囊切除術后早期認知功能的影響和炎癥反應的關系. 陜西醫學雜志, 2015, 44(8): 1003-1005.
13.	莊國雄. 右美托咪定對老年患者術后認知功能及炎癥細胞因子的影響. 海峽藥學, 2015, 27(8): 149-150.
14.	胡建剛, 周天林, 姜博, 等. 右美托咪定術中輸注對老年患者術后認知功能障礙的影響. 上海醫學, 2015, 38(2): 119-123.
15.	張潔茹, 朱虹燕, 苑野, 等. 右美托咪定對老年患者術后早期認知功能障礙的影響. 中國老年學雜志, 2015, 35(5): 1264-1265.
16.	宋娟, 葛亞麗, 龍豐云. 右美托咪定對老年腹腔鏡手術患者術后認知功能的影響. 吉林醫學, 2015, 36(2): 212-214.
17.	金鑫, 金超, 周艷瑾. 右美托咪定對老年患者髖關節置換術后認知功能障礙及圍術期 T 淋巴細胞亞群的影響. 中國藥房, 2016, 27(2): 242-245.
18.	陳杰, 楊欽文. 右美托咪定對老年胸科手術患者術后認知功能的影響. 檢驗醫學與臨床, 2016, 13(15): 2136-2138.
19.	楊彪, 王冬婷, 張瑗, 等. 右美托咪定對腰麻下老年患者髖關節置換術后認知功能的影響. 局解手術學雜志, 2016, 25(8): 570-573.
20.	方梅, 黃小冬, 禚海成, 等. 右美托咪定對老年髖關節手術患者早期認知功能和炎癥因子的影響. 放射免疫學雜志, 2012, 25(5): 548-551.
21.	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.
22.	張在斌, 楊進國, 曾文強, 等. 右美托咪定對老年髖關節置換患者術后應激反應和短期認知功能的影響. 實用藥物與臨床, 2017, 20(1): 34-38.
23.	王羲鳳, 華福洲, 劉偉成, 等. 不同劑量右美托咪定對老年脊柱手術患者免疫功能及認知功能的影響. 廣東醫學, 2015, 36(2): 308-310.
24.	高金蓉, 曾錦明. 右美托咪定對老年甲狀腺根治術患者血清腫瘤壞死因子-α 及術后認知功能的影響. 中國藥業, 2015, 24(8): 33-34.
25.	宋淑敏. 右美托咪定對老年甲狀腺癌根治術患者認知功能和 TNF-α、IL-6、IL-8 水平的影響. 臨床醫學, 2016, 36(2): 3-5.
26.	張海山, 屈鳳, 杜梅青, 等. 右美托咪定對全麻老年患者術后認知功能障礙的影響. 中華麻醉學雜志, 2014, 34(6): 670-673.
27.	Guo Y, Sun L, Zhang J, et al. Preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients. Int J Clin Exp Med, 2015, 8(9): 16183-16190.
28.	Steinmetz J, Christensen KB, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 2009, 110(3): 548-555.
29.	Rosczyk HA, Sparkman NL, Johnson RW. Neuroinflammation and cognitive function in aged mice following minor surgery. Exp Gerontol, 2008, 43(9): 840-846.
30.	Beloosesky Y, Hendel D, Weiss A, et al. Cytokines and C-reactive protein production in hip-fracture-operated elderly patients. J Gerontol A Biol Sci Med Sci, 2007, 62(4): 420-426.
31.	Buvanendran A, Kroin JS, Berger RA, et al. Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology, 2006, 104(3): 403-410.
32.	Taniguchi T, Kurita A, Kobayashi K, et al. Dose- and time-related effects of dexmedetomidine on mortality and inflammatory responses to endotoxin-induced shock in rats. J Anesth, 2008, 22(3): 221-228.
33.	Xiang H, Hu B, Li Z, et al. Dexmedetomidine controls systemic cytokine levels through the cholinergic anti-inflammatory pathway. Inflammation, 2014, 37(5): 1763-1770.
34.	Wu Y, Liu Y, Huang H, et al. Dexmedetomidine inhibits inflammatory reaction in lung tissues of septic rats by suppressing TLR4/NF-κB pathway. Mediators Inflamm, 2013, 2013: 562154.
35.	Terrando N, Monaco C, Ma D, et al. Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline. Proc Natl Acad Sci USA, 2010, 107(47): 20518-20522.
36.	王景華, 張宏. 術后認知功能障礙炎癥反應機制的研究進展. 中華損傷與修復雜志 (電子版), 2014, 9(3): 80-83.
37.	孫曉玉, 高燦. 神經炎癥反應在術后認知功能障礙中作用的研究進展. 國際麻醉學與復蘇雜志, 2016, 37(12): 1130-1134.
38.	Yaffe K, Lindquist K, Penninx BW, et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology, 2003, 61(1): 76-80.
39.	Li JJ, Fang CH. C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases. Med Hypotheses, 2004, 62(4): 499-506.
40.	Liu M, Liang Y, Chigurupati S, et al. Acute kidney injury leads to inflammation and functional changes in the brain. J Am Soc Nephrol, 2008, 19(7): 1360-1370.

1. Deiner S, Silverstein J. Postoperative delirium and cognitive dysfunction. Br J Anaesth, 2009, 103(suppl 1): i41-i46.
2. Moller J, Cluitmans P, Rasmussen L, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet, 1998, 351(9106): 857-861.
3. 闞敏慧, 肖瑋, 王天龍. 老年人中樞炎癥反應與認知功能障礙的相關性研究進展. 國際麻醉學與復蘇雜志, 2016, 37(8): 718-722.
4. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). Available at: 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. 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.
7. 葉壯. 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. 中外醫療, 2014, 33(7): 102-103.
8. 付繼軍. 右美托咪定對老年髖關節置換術患者早期認知功能及 IL-1、IL-6、TNF-α 的影響. 中國醫藥指南, 2014, 12(27): 153-155.
9. 孟海兵, 來偉, 帥君, 等. 右美托咪定對老年患者全麻術后認知功能及炎癥因子的影響. 實用醫學雜志, 2014, 30(14): 2300-2301.
10. 丁玲玲, 張宏, 米衛東, 等. 右美托咪定對老年患者在機器人輔助腹腔鏡手術麻醉蘇醒期及術后認知功能的影響. 中南大學學報 (醫學版), 2015, 40(2): 129-135.
11. 曹福羊, 馬麗, 李娟, 等. 右美托咪定輔助全身麻醉對老年結直腸癌患者術后早期認知功能的影響. 山東醫藥, 2015, 55(40): 76-78.
12. 鈔海蓮, 趙莉, 李榮, 等. 右美托咪定對腹腔鏡膽囊切除術后早期認知功能的影響和炎癥反應的關系. 陜西醫學雜志, 2015, 44(8): 1003-1005.
13. 莊國雄. 右美托咪定對老年患者術后認知功能及炎癥細胞因子的影響. 海峽藥學, 2015, 27(8): 149-150.
14. 胡建剛, 周天林, 姜博, 等. 右美托咪定術中輸注對老年患者術后認知功能障礙的影響. 上海醫學, 2015, 38(2): 119-123.
15. 張潔茹, 朱虹燕, 苑野, 等. 右美托咪定對老年患者術后早期認知功能障礙的影響. 中國老年學雜志, 2015, 35(5): 1264-1265.
16. 宋娟, 葛亞麗, 龍豐云. 右美托咪定對老年腹腔鏡手術患者術后認知功能的影響. 吉林醫學, 2015, 36(2): 212-214.
17. 金鑫, 金超, 周艷瑾. 右美托咪定對老年患者髖關節置換術后認知功能障礙及圍術期 T 淋巴細胞亞群的影響. 中國藥房, 2016, 27(2): 242-245.
18. 陳杰, 楊欽文. 右美托咪定對老年胸科手術患者術后認知功能的影響. 檢驗醫學與臨床, 2016, 13(15): 2136-2138.
19. 楊彪, 王冬婷, 張瑗, 等. 右美托咪定對腰麻下老年患者髖關節置換術后認知功能的影響. 局解手術學雜志, 2016, 25(8): 570-573.
20. 方梅, 黃小冬, 禚海成, 等. 右美托咪定對老年髖關節手術患者早期認知功能和炎癥因子的影響. 放射免疫學雜志, 2012, 25(5): 548-551.
21. 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.
22. 張在斌, 楊進國, 曾文強, 等. 右美托咪定對老年髖關節置換患者術后應激反應和短期認知功能的影響. 實用藥物與臨床, 2017, 20(1): 34-38.
23. 王羲鳳, 華福洲, 劉偉成, 等. 不同劑量右美托咪定對老年脊柱手術患者免疫功能及認知功能的影響. 廣東醫學, 2015, 36(2): 308-310.
24. 高金蓉, 曾錦明. 右美托咪定對老年甲狀腺根治術患者血清腫瘤壞死因子-α 及術后認知功能的影響. 中國藥業, 2015, 24(8): 33-34.
25. 宋淑敏. 右美托咪定對老年甲狀腺癌根治術患者認知功能和 TNF-α、IL-6、IL-8 水平的影響. 臨床醫學, 2016, 36(2): 3-5.
26. 張海山, 屈鳳, 杜梅青, 等. 右美托咪定對全麻老年患者術后認知功能障礙的影響. 中華麻醉學雜志, 2014, 34(6): 670-673.
27. Guo Y, Sun L, Zhang J, et al. Preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients. Int J Clin Exp Med, 2015, 8(9): 16183-16190.
28. Steinmetz J, Christensen KB, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 2009, 110(3): 548-555.
29. Rosczyk HA, Sparkman NL, Johnson RW. Neuroinflammation and cognitive function in aged mice following minor surgery. Exp Gerontol, 2008, 43(9): 840-846.
30. Beloosesky Y, Hendel D, Weiss A, et al. Cytokines and C-reactive protein production in hip-fracture-operated elderly patients. J Gerontol A Biol Sci Med Sci, 2007, 62(4): 420-426.
31. Buvanendran A, Kroin JS, Berger RA, et al. Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology, 2006, 104(3): 403-410.
32. Taniguchi T, Kurita A, Kobayashi K, et al. Dose- and time-related effects of dexmedetomidine on mortality and inflammatory responses to endotoxin-induced shock in rats. J Anesth, 2008, 22(3): 221-228.
33. Xiang H, Hu B, Li Z, et al. Dexmedetomidine controls systemic cytokine levels through the cholinergic anti-inflammatory pathway. Inflammation, 2014, 37(5): 1763-1770.
34. Wu Y, Liu Y, Huang H, et al. Dexmedetomidine inhibits inflammatory reaction in lung tissues of septic rats by suppressing TLR4/NF-κB pathway. Mediators Inflamm, 2013, 2013: 562154.
35. Terrando N, Monaco C, Ma D, et al. Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline. Proc Natl Acad Sci USA, 2010, 107(47): 20518-20522.
36. 王景華, 張宏. 術后認知功能障礙炎癥反應機制的研究進展. 中華損傷與修復雜志 (電子版), 2014, 9(3): 80-83.
37. 孫曉玉, 高燦. 神經炎癥反應在術后認知功能障礙中作用的研究進展. 國際麻醉學與復蘇雜志, 2016, 37(12): 1130-1134.
38. Yaffe K, Lindquist K, Penninx BW, et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology, 2003, 61(1): 76-80.
39. Li JJ, Fang CH. C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases. Med Hypotheses, 2004, 62(4): 499-506.
40. Liu M, Liang Y, Chigurupati S, et al. Acute kidney injury leads to inflammation and functional changes in the brain. J Am Soc Nephrol, 2008, 19(7): 1360-1370.

Chinese Journal of Evidence-Based Medicine

Influence of dexmedetomidine on early postoperative cognitive dysfunction and inflammatory factors in elderly patients: a meta-analysis

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