右美托咪定对全身麻醉下行非心脏手术老年患者术后早期认知功能影响的Meta分析

Effects of dexmedetomidine on early postoperative cognitive function after non-cardiac surgery in elderly patients:a meta-analysis

目的通过Meta分析的方法探讨右美托咪定对全身麻醉下行非心脏手术老年患者术后认知功能的影响。方法计算机检索Cochrane Library、MEDLINE、EMbase、Ovid、Springer、CBM、CNKI、VIP和WanFang Data,同时手工检索图书馆馆藏期刊,检索年限为数据库建库至2016年10月。收集国内外研究人员发表的关于右美托咪定对全身麻醉下行非心脏手术老年患者术后认知功能影响的随机对照临床试验(RCT),由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评估方法学质量。采用RevMan 5.3软件,对符合标准的文献进行Meta分析。结果共纳入22篇RCT,1 713例患者。Meta分析结果显示:术后1、3、7d右美托咪定组的简易智能量表(MMSE)评分明显高于对照组[MD(95%CI)分别为2.99(2.25,3.74),1.66(0.68,2.64),1.52(0.55,2.49)](P<0.05);右美托咪定组术后神经元特异性烯醇化酶(NSE)、S100β蛋白、促炎症细胞因子TNF-α及IL-6水平明显低于生理盐水组(P<0.05)。结论围术期应用右美托咪定可抑制术中应激反应和炎性反应,改善非心脏手术老年患者术后早期认知功能。

Objective To explore the effects of dexmedetomidine on postoperative cognitive function after non-cardiac surgery in elderly patients by meta-analysis.Methods We searched Cochrane Library,MEDLINE,EMbase,Ovid,Springer,China Biology Medicine,CNKI,VIP and WanFang Data for controlled clinical trials.All randomized controlled trials（RCT）that meet their standards of dexmedetomidine on postoperative cognitive function after non-cardiac surgery in elderly patients were collected. The meta-analysis was performed by Review Manager 5.3.Results Twenty-two trials with 1713 patients were included in this meta-analysis.The results of meta-analysis showed that：Mini-mental state examination（MMSE）MD=2.99,95%CI（2.25,3.74）one day before operation,MD=1.66,95%CI（0.68,2.64）three days after operation,MD=1.52,95%CI（0.55,2.49）seven days after operation,respectively（P〈0.05）;Perioperative dexmedetomidine treatment was significantly associated with better neurocognitive performance in comparison with saline.Compared with normal saline group,the serum concerntrations of neuron-specificenolase,S100β protein, TNF-α and IL-6 were significantly decreased in dexmedetomidine group.Conclusion The present meta-analysis indicates that dexmedetomidine shows superiority over placebo in early postoperative neurocognitive function after non-cardiac surgery in elderly patients.