Meta-analysis Of The Effect Of Dexmedetomidine On The Incidence Of Postoperative Delirium During The Operation

Background:Postoperative delirium is a common complication after surgery,and the patient has a poor prognosis.The prevention and treatment of postoperative delirium is the focus of clinical work,but the consensus at domestic and abroad is not completely consistent.The American ICU guidelines for the clinical treatment of adult agitation and delirium and the American Society for the Promotion of Recovery’s consensus on the prevention of postoperative delirium all indicate that dexmedetomidine has a therapeutic effect on delirium,but there is insufficient evidence to show that it can prevent postoperative delirium^[1.2].The expert consensus on the clinical application of dexmedetomidine in China introduced its role in the treatment and prevention of postoperative delirium^[3].Since there are still differences in opinions at domestic and abroad,this article conducted a meta-analysis to comprehensively evaluate intraoperative application The effect of dexmedetomidine on the incidence of postoperative delirium in patients.Objectie:This meta-analysis of the literature on Intraoperative use of dexmedetomidine.the relative risk as an evaluation index are used to evaluate the incidence of delirium,bradycardia,hypotension,and hypertension.Hope to provide reference for the prevention of delirium.Methods:Systematic search of Cochrane database,Pub Med and Chinese full-text database,comprehensive collection of Chinese and English related literature on dexmedetomidine during surgery from January 1990 to December 2019,and screening based on literature inclusion and exclusion criteria,and The results of the screening were analyzed using Rev Man5.3software for meta-analysis,and the relative risk was used as an evaluation index to evaluate the incidence of delirium after surgery,the incidence of Intraoperative bradycardia,the incidence of Intraoperative hypotension,and the incidence of Intraoperative hypertension.Results:This article included a total of 27 literatures,13 English literatures,14 Chinese literatures,a total of 5373 surgical patients,2707 cases in the dexmedetomidine test group,and 2666 cases in the other drug control group.Meta analysis shows that dexmedetomidine can reduce the incidence of postoperative delirium[RR=0.43（95%CI:0.35-0.52）,Z=8.35（P<0.00001）],but the incidence of bradycardia is slow[RR=1.59（95%CI:1.20-2.11）,Z=3.26（P<0.00001）],the incidence of intraoperative hypotension[RR=1.47（95%CI:1.10-1.97）,Z=2.63（P=0.009）]Increased,there was no statistically significant difference in the incidence of intraoperative hypertension[RR=0.86（95%CI:0.63-1.19）,Z=0.9（P=0.37）].Subgroup analysis showed:dexmedetomidine,before or after induction,was used loading dose or without it,control group was normal saline or propofol,dexmedetomidine both can reduce the incidence of postoperative delirium.intraoperative application of dexmedetomidine can not only reduce the incidence of delirium after cardiac surgery,but also non-cardiac surgery.Conclusins:Intraoperative application of dexmedetomidine reduces the incidence of postoperative delirium in surgical patients,but this comes at the cost of increasing the incidence of hypotension and bradycardia.