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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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, 江伟.术后认知功能障碍研究进展.医学综述, 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.	赵冰洁, 刘洋, 李仔楠, 等.右旋美托咪啶在围术期的应用进展.中国保健营养(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.	莫坚, 莫桂熙, 刘亦君, 等.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.实用医学杂志, 2012, 28(24):4150-4152.
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.中国老年学杂志, 2012, 32(22):5050-5051.
7.	陈靖军, 张三虎, 李克寒, 等.盐酸右美托咪定对老年结肠癌患者术后认知功能的影响.中国实用医药, 2012, 7(6):171-172.
8.	陈力, 李传翔, 宋伏虎, 等.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.广东医学, 2012, 33(21):3321-3323.
9.	全承炫, 欧阳文.右旋美托咪定在老年患者腰椎手术中的临床应用及其对术后认知功能的影响.长沙:中南大学, 2011.
10.	项余华, 叶月利, 罗苹, 等.右美托咪啶对老年人术后认知功能的影响.中国中西医结合外科杂志, 2012, 18(4):358-360.
11.	幸志强, 陶明哲.右美托咪啶对老年患者术后认知功能的影响.现代医院, 2012, 12(2):18-19.
12.	余潇, 张孟元.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.济南:山东大学, 2012.
13.	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.中国中西医结合外科杂志, 2012, 18(6):568-571.
14.	吕安庆, 陈文迪.右美托咪定联合全麻下老年患者术后认知功能与脑氧代谢的关系.河北医科大学学报, 2012, 33(3):299-301.
15.	张伟, 张加强, 孟凡民.不同剂量右美托咪定麻醉对食管癌根治术患者术后认知功能的影响.山东医药, 2013, 53(7):15-18.
16.	张奕文, 何忠承, 石世坚, 等.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.广东医学, 2012, 33(14):2172-2174.
17.	李爱梅, 石翊飒, 高瑞萍, 等.不同剂量右美托咪定对脑膜瘤切除术患者术后认知功能的影响.临床麻醉学杂志, 2013, 29(7):665-668.
18.	李丽妍, 黄金平, 刘桦, 等.右美托咪定对老年患者髋关节置换术后认知功能的影响.广东医学, 2013, 34(5):781-783.
19.	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.吉林医学, 2012, 33(33):7253-7253.
20.	刘晓华.右美托咪啶对腹腔镜下直肠癌根治术后早期认知功能障碍的影响.实用癌症杂志, 2013, 28(5):527-529.
21.	石双平, 王薇, 胡柳生, 等.右美托咪啶对老年患者非心脏手术后早期认知功能的影响.医学临床研究, 2012, 29(12):2289-2291.
22.	孙章楠, 董振明.右美托咪定对老年患者腹部手术术后认知功能的影响.石家庄:河北医科大学, 2013.
23.	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.中国老年学杂志, 2013, 33(13):3167-3168.
24.	薛晓英, 何海燕, 谭秀娟, 等.右美托咪啶对老年患者腹腔镜胆囊切除术术后认知功能的影响.中国当代医药, 2013, 20(17):105-106.
25.	朱虹燕, 周春燕.右美托咪定对老年患者术后认知功能及炎症因子的影响.长春:吉林医科大学, 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.	王丽美, 常小丽, 任许利, 等.心脏手术后右美托咪定镇静效果的Meta分析.中国循证医学杂志, 2013, 13(1):93-99.
29.	卓帅, 郑剑桥, 刘斌.右美托咪啶和丙泊酚对术后ICU患者镇静效果的系统评价.中国循证医学杂志, 2012, 12(6):686-693.
30.	裴皓.盐酸右美托咪定的药理作用与临床应用.医药导报, 2010, 29(12):1603-1607.
31.	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.中国临床药理学杂志, 2007, 23(6):466-470.
32.	李静.老年患者非心脏术后认知功能障碍.医学综述, 2009, 15(20):3107-3109.
33.	Rasmussen LS. Defining postoperative cognitive dysfunction. Eur J Anaesth, 1998, 15(6):761-764.
34.	李颖川, 安一凡, 董维华, 等.老年患者全髋关节置换术后认知功能障碍与围术期炎性反应的相关性.上海医学, 2011, 34(4):249-252.
35.	郭浩翔, 金立民, 崔常雷, 等.炎症对老年患者术后认知功能障碍影响的研究进展.中国老年学杂志, 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.	刘海林, 钱燕宁.右美托咪定对心脏瓣膜置换术患者围术期炎性反应的影响.中国应用生理学杂志, 2013, 29(4):316-317.
41.	施彩凤, 张林, 陈思佳, 等.右旋美托咪啶在全麻诱导中对脑电双频谱及血流动力学指数的影响.青岛大学医学院学报, 2012, 48(01):59-61.

1. 李琪, 江伟.术后认知功能障碍研究进展.医学综述, 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. 赵冰洁, 刘洋, 李仔楠, 等.右旋美托咪啶在围术期的应用进展.中国保健营养(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. 莫坚, 莫桂熙, 刘亦君, 等.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.实用医学杂志, 2012, 28(24):4150-4152.
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.中国老年学杂志, 2012, 32(22):5050-5051.
7. 陈靖军, 张三虎, 李克寒, 等.盐酸右美托咪定对老年结肠癌患者术后认知功能的影响.中国实用医药, 2012, 7(6):171-172.
8. 陈力, 李传翔, 宋伏虎, 等.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.广东医学, 2012, 33(21):3321-3323.
9. 全承炫, 欧阳文.右旋美托咪定在老年患者腰椎手术中的临床应用及其对术后认知功能的影响.长沙:中南大学, 2011.
10. 项余华, 叶月利, 罗苹, 等.右美托咪啶对老年人术后认知功能的影响.中国中西医结合外科杂志, 2012, 18(4):358-360.
11. 幸志强, 陶明哲.右美托咪啶对老年患者术后认知功能的影响.现代医院, 2012, 12(2):18-19.
12. 余潇, 张孟元.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.济南:山东大学, 2012.
13. 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.中国中西医结合外科杂志, 2012, 18(6):568-571.
14. 吕安庆, 陈文迪.右美托咪定联合全麻下老年患者术后认知功能与脑氧代谢的关系.河北医科大学学报, 2012, 33(3):299-301.
15. 张伟, 张加强, 孟凡民.不同剂量右美托咪定麻醉对食管癌根治术患者术后认知功能的影响.山东医药, 2013, 53(7):15-18.
16. 张奕文, 何忠承, 石世坚, 等.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.广东医学, 2012, 33(14):2172-2174.
17. 李爱梅, 石翊飒, 高瑞萍, 等.不同剂量右美托咪定对脑膜瘤切除术患者术后认知功能的影响.临床麻醉学杂志, 2013, 29(7):665-668.
18. 李丽妍, 黄金平, 刘桦, 等.右美托咪定对老年患者髋关节置换术后认知功能的影响.广东医学, 2013, 34(5):781-783.
19. 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.吉林医学, 2012, 33(33):7253-7253.
20. 刘晓华.右美托咪啶对腹腔镜下直肠癌根治术后早期认知功能障碍的影响.实用癌症杂志, 2013, 28(5):527-529.
21. 石双平, 王薇, 胡柳生, 等.右美托咪啶对老年患者非心脏手术后早期认知功能的影响.医学临床研究, 2012, 29(12):2289-2291.
22. 孙章楠, 董振明.右美托咪定对老年患者腹部手术术后认知功能的影响.石家庄:河北医科大学, 2013.
23. 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.中国老年学杂志, 2013, 33(13):3167-3168.
24. 薛晓英, 何海燕, 谭秀娟, 等.右美托咪啶对老年患者腹腔镜胆囊切除术术后认知功能的影响.中国当代医药, 2013, 20(17):105-106.
25. 朱虹燕, 周春燕.右美托咪定对老年患者术后认知功能及炎症因子的影响.长春:吉林医科大学, 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. 王丽美, 常小丽, 任许利, 等.心脏手术后右美托咪定镇静效果的Meta分析.中国循证医学杂志, 2013, 13(1):93-99.
29. 卓帅, 郑剑桥, 刘斌.右美托咪啶和丙泊酚对术后ICU患者镇静效果的系统评价.中国循证医学杂志, 2012, 12(6):686-693.
30. 裴皓.盐酸右美托咪定的药理作用与临床应用.医药导报, 2010, 29(12):1603-1607.
31. 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.中国临床药理学杂志, 2007, 23(6):466-470.
32. 李静.老年患者非心脏术后认知功能障碍.医学综述, 2009, 15(20):3107-3109.
33. Rasmussen LS. Defining postoperative cognitive dysfunction. Eur J Anaesth, 1998, 15(6):761-764.
34. 李颖川, 安一凡, 董维华, 等.老年患者全髋关节置换术后认知功能障碍与围术期炎性反应的相关性.上海医学, 2011, 34(4):249-252.
35. 郭浩翔, 金立民, 崔常雷, 等.炎症对老年患者术后认知功能障碍影响的研究进展.中国老年学杂志, 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. 刘海林, 钱燕宁.右美托咪定对心脏瓣膜置换术患者围术期炎性反应的影响.中国应用生理学杂志, 2013, 29(4):316-317.
41. 施彩凤, 张林, 陈思佳, 等.右旋美托咪啶在全麻诱导中对脑电双频谱及血流动力学指数的影响.青岛大学医学院学报, 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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