在手术期间使用德克斯梅多米丁预防手术后认知功能障碍和痴呆症的老年患者的脑膜切除术:一个倾向性得分匹配的回顾性研究
Chaojun Tang1, Yalan Li1, Yong Lai1
1Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People's Republic of China.
International journal of general medicine
|June 12, 2024
概括
德克斯梅德托米丁通过减少神经炎症,有效地预防手术后的认知功能障碍和脑膜切除术后的妄想. 这一发现为改善肺部手术后患者的治疗结果提供了一个有希望的策略.
科学领域:
- 麻醉学 麻醉学
- 神经科学是一个神经科学.
- 在瘤学瘤学.
背景情况:
- 手术后认知功能障碍 (POCD) 和妄想是大手术后的严重并发症,特别是带切除术.
- 肺癌手术通常涉及全身麻醉,增加这些神经系统并发症的风险.
- 神经炎症与POCD和痴呆症的发病有关.
研究的目的:
- 为了研究德克斯梅德托米丁在预防手术后认知功能障碍和妄症的疗效,在经过脑管切除术的患者中.
- 评估德克斯梅德托米丁对炎症标志物和神经元损伤指标的影响.
主要方法:
- 一项随机对照试验,涉及肺癌患者在全身麻醉下接受胸腔镜叶切除术.
- 患者被分为德克斯梅德托米丁和对照组,使用倾向-得分匹配 (PSM) 来平衡混变量 (87名患者每组PSM后).
- 主要结局包括术后认知功能 (MoCA分数) 和妄想发病率. 二次结局测量了TNF-α,IL-6和S100β蛋白的血度.
主要成果:
- 群体之间的人口统计或血液动力学没有显著差异.
- 与对照组 (P<0.01) 相比,德克斯梅德托米丁组在手术后7天显示出显著更高的MoCA得分和更低的妄想发作率.
- 在德克斯梅托米丁组中,TNF-α,IL-6和S100β蛋白的血水平显著降低 (P<0.01),具有类似的不良事件率.
结论:
- 德克斯梅德托米丁在脑膜切除术患者中显示出对术后认知功能障碍和痴呆症的保护作用.
- 该机制涉及抑制神经炎症,由TNF-α和IL-6水平的降低表明.
- 德克斯梅德托米丁是缓解肺部手术后神经系统并发症的潜在治疗药物.
相关概念视频
Parenteral Anesthetics: Overview
118
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
118
Stages of General Anesthesia
418
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
418
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
72
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
72
Skeletal Muscle Relaxants: Therapeutic Uses
480
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
480
Depolarizing Blockers: Pharmocokinetics
319
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
319
General Anesthesia: Overview
212
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
212


