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氯胺酮与右美托咪定预防老年急诊手术患者术后谵妄的随机、双盲、安慰剂对照研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：王波 编辑：王婷婷 审校：曹莹
背景：研究目的是评估在全身麻醉诱导前单剂量氯胺酮或右美托咪定是否可以降低接受急诊手术的老年患者术后谵妄（主要结局）或认知功能障碍（次要结局）的发生率。
患者及方法：这项研究包含60名计划进行紧急手术的老年患者。采用随机、双盲、安慰剂对照试验方法。将患者随机分为3组（n = 20）：I组给予0.9%生理盐水，II组给予1µg/kg右美托咪定，III组在麻醉诱导前给予1 mg/kg氯胺酮。术后观察患者3天，分别用谵妄观察筛查量表和精神状态检查评分检测术后谵妄和认知功能障碍。
结果：与氯胺酮组和安慰剂组相比，右美托咪定组谵妄（p = 0.001）和认知功能障碍（p = 0.006）的发生率最低。多因素logistic回归模型显示，与安慰剂相比，右美托咪定可使术后谵妄发生率降低32% (OR = 0.684, 95% CI: 0.240-0.971, p = 0.025)，而氯胺酮可使术后谵妄发生率增加3倍（OR = 3.012, 95% CI: 1.185-9.681, p = 0.013）。此外，右美托咪定使术后认知功能障碍发生率降低62% (OR = 0.375, 95% CI: 0.091-0.543, p = 0.012)，而氯胺酮使术后认知功能障碍发生率增加4.5倍（OR = 4.501, 95% CI: 1.161-8.817, p = 0.006）。
结论：右美托咪定单次麻醉前推注是预防急诊手术老年患者术后谵妄的实用选择。
A pre-anesthetic bolus of ketamine versus dexmedetomidine for prevention of postoperative delirium in elderly patients undergoing emergency surgery: a randomized, double-blinded, placebo controlled study
Background： We aimed to evaluate whether a single dose of ketamine or dexmedetomidine before induction of general anesthesia could reduce the incidence of postoperative delirium (primary outcome) or cognitive dysfunction (secondary outcome) in elderly patients undergoing emergency surgery.
Patients and methods： This randomized, double-blinded, placebo-controlled trial included 60 elderly patients who were scheduled for emergency surgery. The patients were randomly assigned into one of three groups (n=20): group I received 0.9% normal saline, group II received 1 µg/kg dexmedetomidine, and group III received 1 mg/kg ketamine right before anesthesia induction. Patients were observed for three days after surgery and tested for postoperative delirium and cognitive dysfunction using the delirium observation screening scale and the mini-mental state examination score, respectively.
Results： The dexmedetomidine group had the lowest incidence of delirium (p=0.001) and cognitive dysfunction (p=0.006) compared to the ketamine and placebo groups. The multivariate logistic regression model revealed that dexmedetomidine reduced the incidence of postoperative delirium by 32% compared to placebo (reference) (OR=0.684, 95% CI: 0.240–0.971, p=0.025), whereas ketamine increased the risk by threefold (OR=3.012, 95% CI: 1.185–9.681, p=0.013). Furthermore, dexmedetomidine reduced the incidence of postoperative cognitive dysfunction by 62% (OR=0.375, 95% CI: 0.091–0.543, p=0.012), whereas ketamine increased the risk by 4.5 times (OR=4.501, 95% CI: 1.161–8.817, p=0.006). Conclusion： A single pre-anesthetic bolus of dexmedetomidine is a practical choice for preventing postoperative delirium in elderly patients undergoing emergency surgery
