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.	阚敏慧, 肖玮, 王天龙. 老年人中枢炎症反应与认知功能障碍的相关性研究进展. 国际麻醉学与复苏杂志, 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.	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.
7.	叶壮. 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. 中外医疗, 2014, 33(7): 102-103.
8.	付继军. 右美托咪定对老年髋关节置换术患者早期认知功能及 IL-1、IL-6、TNF-α 的影响. 中国医药指南, 2014, 12(27): 153-155.
9.	孟海兵, 来伟, 帅君, 等. 右美托咪定对老年患者全麻术后认知功能及炎症因子的影响. 实用医学杂志, 2014, 30(14): 2300-2301.
10.	丁玲玲, 张宏, 米卫东, 等. 右美托咪定对老年患者在机器人辅助腹腔镜手术麻醉苏醒期及术后认知功能的影响. 中南大学学报 (医学版), 2015, 40(2): 129-135.
11.	曹福羊, 马丽, 李娟, 等. 右美托咪定辅助全身麻醉对老年结直肠癌患者术后早期认知功能的影响. 山东医药, 2015, 55(40): 76-78.
12.	钞海莲, 赵莉, 李荣, 等. 右美托咪定对腹腔镜胆囊切除术后早期认知功能的影响和炎症反应的关系. 陕西医学杂志, 2015, 44(8): 1003-1005.
13.	庄国雄. 右美托咪定对老年患者术后认知功能及炎症细胞因子的影响. 海峡药学, 2015, 27(8): 149-150.
14.	胡建刚, 周天林, 姜博, 等. 右美托咪定术中输注对老年患者术后认知功能障碍的影响. 上海医学, 2015, 38(2): 119-123.
15.	张洁茹, 朱虹燕, 苑野, 等. 右美托咪定对老年患者术后早期认知功能障碍的影响. 中国老年学杂志, 2015, 35(5): 1264-1265.
16.	宋娟, 葛亚丽, 龙丰云. 右美托咪定对老年腹腔镜手术患者术后认知功能的影响. 吉林医学, 2015, 36(2): 212-214.
17.	金鑫, 金超, 周艳瑾. 右美托咪定对老年患者髋关节置换术后认知功能障碍及围术期 T 淋巴细胞亚群的影响. 中国药房, 2016, 27(2): 242-245.
18.	陈杰, 杨钦文. 右美托咪定对老年胸科手术患者术后认知功能的影响. 检验医学与临床, 2016, 13(15): 2136-2138.
19.	杨彪, 王冬婷, 张瑗, 等. 右美托咪定对腰麻下老年患者髋关节置换术后认知功能的影响. 局解手术学杂志, 2016, 25(8): 570-573.
20.	方梅, 黄小冬, 禚海成, 等. 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. 放射免疫学杂志, 2012, 25(5): 548-551.
21.	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.
22.	张在斌, 杨进国, 曾文强, 等. 右美托咪定对老年髋关节置换患者术后应激反应和短期认知功能的影响. 实用药物与临床, 2017, 20(1): 34-38.
23.	王羲凤, 华福洲, 刘伟成, 等. 不同剂量右美托咪定对老年脊柱手术患者免疫功能及认知功能的影响. 广东医学, 2015, 36(2): 308-310.
24.	高金蓉, 曾锦明. 右美托咪定对老年甲状腺根治术患者血清肿瘤坏死因子-α 及术后认知功能的影响. 中国药业, 2015, 24(8): 33-34.
25.	宋淑敏. 右美托咪定对老年甲状腺癌根治术患者认知功能和 TNF-α、IL-6、IL-8 水平的影响. 临床医学, 2016, 36(2): 3-5.
26.	张海山, 屈凤, 杜梅青, 等. 右美托咪定对全麻老年患者术后认知功能障碍的影响. 中华麻醉学杂志, 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.	王景华, 张宏. 术后认知功能障碍炎症反应机制的研究进展. 中华损伤与修复杂志 (电子版), 2014, 9(3): 80-83.
37.	孙晓玉, 高灿. 神经炎症反应在术后认知功能障碍中作用的研究进展. 国际麻醉学与复苏杂志, 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. 阚敏慧, 肖玮, 王天龙. 老年人中枢炎症反应与认知功能障碍的相关性研究进展. 国际麻醉学与复苏杂志, 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. 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.
7. 叶壮. 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. 中外医疗, 2014, 33(7): 102-103.
8. 付继军. 右美托咪定对老年髋关节置换术患者早期认知功能及 IL-1、IL-6、TNF-α 的影响. 中国医药指南, 2014, 12(27): 153-155.
9. 孟海兵, 来伟, 帅君, 等. 右美托咪定对老年患者全麻术后认知功能及炎症因子的影响. 实用医学杂志, 2014, 30(14): 2300-2301.
10. 丁玲玲, 张宏, 米卫东, 等. 右美托咪定对老年患者在机器人辅助腹腔镜手术麻醉苏醒期及术后认知功能的影响. 中南大学学报 (医学版), 2015, 40(2): 129-135.
11. 曹福羊, 马丽, 李娟, 等. 右美托咪定辅助全身麻醉对老年结直肠癌患者术后早期认知功能的影响. 山东医药, 2015, 55(40): 76-78.
12. 钞海莲, 赵莉, 李荣, 等. 右美托咪定对腹腔镜胆囊切除术后早期认知功能的影响和炎症反应的关系. 陕西医学杂志, 2015, 44(8): 1003-1005.
13. 庄国雄. 右美托咪定对老年患者术后认知功能及炎症细胞因子的影响. 海峡药学, 2015, 27(8): 149-150.
14. 胡建刚, 周天林, 姜博, 等. 右美托咪定术中输注对老年患者术后认知功能障碍的影响. 上海医学, 2015, 38(2): 119-123.
15. 张洁茹, 朱虹燕, 苑野, 等. 右美托咪定对老年患者术后早期认知功能障碍的影响. 中国老年学杂志, 2015, 35(5): 1264-1265.
16. 宋娟, 葛亚丽, 龙丰云. 右美托咪定对老年腹腔镜手术患者术后认知功能的影响. 吉林医学, 2015, 36(2): 212-214.
17. 金鑫, 金超, 周艳瑾. 右美托咪定对老年患者髋关节置换术后认知功能障碍及围术期 T 淋巴细胞亚群的影响. 中国药房, 2016, 27(2): 242-245.
18. 陈杰, 杨钦文. 右美托咪定对老年胸科手术患者术后认知功能的影响. 检验医学与临床, 2016, 13(15): 2136-2138.
19. 杨彪, 王冬婷, 张瑗, 等. 右美托咪定对腰麻下老年患者髋关节置换术后认知功能的影响. 局解手术学杂志, 2016, 25(8): 570-573.
20. 方梅, 黄小冬, 禚海成, 等. 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. 放射免疫学杂志, 2012, 25(5): 548-551.
21. 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.
22. 张在斌, 杨进国, 曾文强, 等. 右美托咪定对老年髋关节置换患者术后应激反应和短期认知功能的影响. 实用药物与临床, 2017, 20(1): 34-38.
23. 王羲凤, 华福洲, 刘伟成, 等. 不同剂量右美托咪定对老年脊柱手术患者免疫功能及认知功能的影响. 广东医学, 2015, 36(2): 308-310.
24. 高金蓉, 曾锦明. 右美托咪定对老年甲状腺根治术患者血清肿瘤坏死因子-α 及术后认知功能的影响. 中国药业, 2015, 24(8): 33-34.
25. 宋淑敏. 右美托咪定对老年甲状腺癌根治术患者认知功能和 TNF-α、IL-6、IL-8 水平的影响. 临床医学, 2016, 36(2): 3-5.
26. 张海山, 屈凤, 杜梅青, 等. 右美托咪定对全麻老年患者术后认知功能障碍的影响. 中华麻醉学杂志, 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. 王景华, 张宏. 术后认知功能障碍炎症反应机制的研究进展. 中华损伤与修复杂志 (电子版), 2014, 9(3): 80-83.
37. 孙晓玉, 高灿. 神经炎症反应在术后认知功能障碍中作用的研究进展. 国际麻醉学与复苏杂志, 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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