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Research Progress on the Prevention of Postoperative Delirium in Elderly Patients by Dexamethasone
Received date: 2024-12-23
Revised date: 2025-06-04
Accepted date: 2025-11-15
Online published: 2025-12-24
Postoperative delirium （POD） is a prevalent acute neurocognitive disorder in elderly patients during the perioperative period， characterized by attention deficits， fluctuating consciousness， and behavioral abnormalities， which significantly increases the risk of long-term cognitive decline and healthcare burden. Key risk factors include advanced age （> 65 years）， preoperative cognitive impairment， and complex surgery. The pathological mechanisms involve multi-system interactions， such as neuroinflammatory cascades， cerebral hemodynamic disturbances， and neuroendocrine dysregulation. Dexamethasone， a potent glucocorticoid， demonstrates potential for mitigating POD risk through mechanisms including suppression of neuroinflammation by inhibiting the TLR4/NF-κB pathway， modulation of hypothalamic-pituitary-adrenal （HPA） axis function， restoration of cholinergic-dopaminergic balance， and improvement of metabolic homeostasis. Clinical studies indicate that its efficacy is significantly influenced by administration routes， dosage and genetic background. Current controversies center on the sensitivity of assessment tools， heterogeneity in drug response across surgical types， and long-term neurological safety. This review focuses on the preventive effect of DEX against POD in elderly patients， aiming to provide references for clinical research. Future research should integrate gene-guided personalized therapies， multi-target combination therapies （e.g.， co-administration with melatonin or NSAIDs）， and dynamic monitoring technologies to optimize risk-benefit balance and advance perioperative management toward precision and systematization.
Key words： Dexamethasone； ; Postoperative delirium； ; Mechanism； ; Prevention strategy
YUAN Yuan, WU Bingbing, WANG Huiwen
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Research Progress on the Prevention of
Postoperative Delirium in Elderly Patients by Dexamethasone
［1］ Huang JX， Zhang SS， Wang SX， et al. The role of perioperative sedative anesthetics in preventing postoperative delirium： a systematic review and network-meta analysis including 6679 patients［J］.BMC Cardiovasc Disord， 2024，24（1）：147.
［2］ Shi HJ， Zhuang MY， Hu JH， et al. Use of dexmedetomidine during light versus deep anaesthesia on postoperative delirium among elderly patients undergoing major non-cardiac surgery： protocol for a multicentre randomised factorial trial［J］.BMJ Open， 2024，14（10）：e083312.
［3］ Ye C， Shen J， Zhang C， et al. Impact of intraoperative dexmedetomidine on postoperative delirium and pro-inflammatory cytokine levels in elderly patients undergoing thoracolumbar compression fracture surgery： a prospective， randomized， placebo-controlled clinical trial［J］.Medicine（Baltimore）， 2024，103（18）：e37931.
［4］ Lau KT， Chiu LCS， Fong JSY， et al. Preoperative cognitive training for the prevention of postoperative delirium and cognitive dysfunction： a systematic review and meta-analysis［J］.Perioper Med （Lond）， 2024，13（1）：113.
［5］ Yan F， Chen B， Ma Z， et al. Exploring molecular mechanisms of postoperative delirium through multi-omics strategies in plasma exosomes［J］.Sci Rep， 2024，14（1）：29466.
［6］ Fenta E， Teshome D， Kibret S， et al. Incidence and risk factors of postoperative delirium in elderly surgical patients 2023［J］.Sci Rep， 2025，15（1）：1400.
［7］ Chen N， Xie QM， Song SM， et al. Dexamethasone protects against asthma via regulating Hif-1α-glycolysis-lactate axis and protein lactylation［J］.Int Immunopharmacol， 2024，131：111791.
［8］ Wu H， Yan S， Cao H， et al. Unraveling the impact of frailty on postoperative delirium in elderly surgical patients： a systematic review and meta-analysis［J］.BMC Anesthesiol， 2025，25（1）：114.
［9］ Chen A， An E， Yan E， et al. Prevalence of preoperative depression and adverse outcomes in older patients undergoing elective surgery： a systematic review and meta-analysis［J］.J Clin Anesth， 2024，97：111532.
［10］ Huang H， Li H， Zhang X， et al. Association of postoperative delirium with cognitive outcomes： a meta-analysis［J］.J Clin Anesth， 2021，75：110496.
［11］ Menzenbach J， Frede S， Petras J， et al. Perioperative vascular biomarker Profiling in elective surgery patients developing postoperative delirium： a prospective cohort study［J］.Biomedicines， 2021，9（5）：553.
［12］ Deschamps A， Ben Abdallah A， Jacobsohn E， et al. electroencephalography-guided anesthesia and delirium in older adults after cardiac surgery： The ENGAGES-Canada Randomized Clinical Trial［J］.JAMA， 2024，332（2）：112-123.
［13］ 吴前胜，曾莹，王兰，等.体外循环下心脏手术患者术后谵妄管理的循证实践［J］.中华护理杂志， 2024，59（3）：292-299.
［14］ Li Y， Zhu L. Effect of perioperative benzodiazepine use on intraoperative awareness and postoperative delirium［J］.Br J Anaesth， 2023，131（6）：e201-e202.
［15］ Swarbrick CJ， Partridge JSL. Evidence-based strategies to reduce the incidence of postoperative delirium： a narrative review［J］.Anaesthesia， 2022，77：92-101.
［16］ Cao SJ， Zhang Y， Zhang YX， et al. Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery： a multicentre randomised trial［J］.Brit J Anaesth， 2023，131（2）：253-265.
［17］ Kluger MT， Skarin M， Collier J， et al. Steroids to reduce the impact on delirium （STRIDE）： a double-blind， randomised， placebo-controlled feasibility trial of pre-operative dexamethasone in people with hip fracture［J］.Anaesthesia， 2021，76（8）：1031-1041.
［18］ Descamps R， Amour J， Besnier E， et al. Perioperative individualized hemodynamic optimization according to baseline mean arterial pressure in cardiac surgery patients： rationale and design of the OPTIPAM randomized trial［J］.Am Heart J， 2023，261：10-20.
［19］ Li T， Li J， Yuan L， et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery： the RAGA randomized trial［J］.JAMA，2022，327（1）：50-58.
［20］ 黄运伯，陈素玲，黄剑.TLR4/NF-κB信号通路在七氟烷诱导的术后认知功能障碍老年大鼠中的作用［J］.中国老年学杂志，2021，41（13）：2782-2785.
［21］ 王彩红，刘荣鑫，汤峰，等.小胶质细胞与NLRP3炎症小体在认知功能障碍中作用的研究进展［J］.协和医学杂志，2023，14（6）：1282-1288.
［22］ Rudiger A， Begdeda H， Babic D， et al. Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU［J］.Critical Care （Lond）， 2016， 20： 264.
［23］ 任红，周广伟，付莉莉，等.小剂量艾司氯胺酮对老龄髋关节置换术患者术后谵妄的影响［J］.解放军医学院学报，2023，44（8）：857-861.
［24］ 赵宝.老年全麻非心脏手术患者术后谵妄的系统性研究［D］.山东大学，2018.
［25］ Wang Q， Liu Z， Wang Y， et al. Quantitative chemoproteomics reveals dopamine's protective modification of Tau［J］.Nat Chem Biol， 2025.
［26］ Wilcox MR， Nigam A， Glasgow NG， et al. Inhibition of NMDA receptors through a membrane-to-channel path［J］.Nat Communi， 2022，13（1）：4114.
［27］ 陈慧敏，贾洪峰，江婷婷，等.术中血糖波动和术后胰岛素抵抗对胸腔镜肺癌根治术后老年患者认知功能障碍的影响［J］.天津医药，2024，52（2）：201-205.
［28］ Narasimhan S， Holtzman DM， Apostolova LG， et al. Apolipoprotein E in Alzheimer's disease trajectories and the next-generation clinical care pathway［J］.Nat Neurosci， 2024，27（7）：1236-1252.
［29］ Giesa N， Sekutowicz M， Rubarth K， et al. Applying a transformer architecture to intraoperative temporal dynamics improves the prediction of postoperative delirium［J］.Commun Med（Lond）， 2024，4（1）：251.
［30］ Arkelius K， Wendt T S， Andersson H， et al. LOX-1 and MMP-9 inhibition attenuates the detrimental effects of delayed rt-PA therapy and improves outcomes after acute ischemic stroke［J］.Circ Res， 2024，134（8）：954-969.
［31］ Siburian R， Fadillah R， Altobaishat O， et al. Remote ischemic preconditioning and cognitive dysfunction following coronary artery bypass grafting： a systematic review and meta-analysis of randomized controlled trials［J］.Saudi J Anaesth， 2024，18（2）：187-193.
［32］ Wang T， Huang X， Sun S， et al. Recent advances in the mechanisms of postoperative neurocognitive dysfunction： a narrative review［J］.Biomedicines， 2025，13（1）：115.
［33］ Zhang Y， Wang W， Li J， et al. Dexmedetomidine accelerates photoentrainment and affects sleep structure through the activation of SCN（VIP） neurons［J］.Commun Biol， 2024，7（1）：1707.
［34］ He J， Zhang X， Li C， et al. Dexmedetomidine nasal administration improves perioperative sleep quality and neurocognitive deficits in elderly patients undergoing general anesthesia［J］.BMC Anesthesiol， 2024， 24（1）：42.
［35］ Liang ZK， Xiong W， Wang C， et al. Resolving neuroinflammatory and social deficits in ASD model mice： dexmedetomidine downregulates NF-κB/IL-6 pathway via α2AR［J］.Brain Behav Immun， 2024，119：84-95.
［36］ Huang GR， Hao FG. Dexmedetomidine inhibits inflammation to alleviate early neuronal injury via TLR4/NF-κB pathway in rats with traumatic brain injury［J］.Crit Rev Eukaryot Gene Expr， 2021，31（1）：41-47.
［37］ Kim M， Huh J， Choi H， et al. Impact of dexmedetomidine-based opioid-sparing anesthesia on opioid use after minimally invasive repair of pectus excavatum： a prospective randomized controlled trial［J］.J Clin Med， 2024，13（23）：7264.
［38］ Ning X， Tang J， Li X， et al. Dexmedetomidine ameliorates hepatic ischemia reperfusion injury via modulating SIRT3 mediated mitochondrial quality control［J］.Sci Rep， 2025，15（1）：5630.
［39］ 刘丰华，邱凤玉，伊正君.右美托咪定联合顺铂对Lewis肺癌小鼠免疫功能的影响［J］.现代免疫学，2020，40（5）：386-390.
［40］ Sakic L， Tonkovicc D， Hrgovic Z， et al. Spinal dexamethasone effect on cognitive disorders after hip surgery［J］.Med Arch， 2023，77（1）：18-23.
［41］ 邓楚娇，刘可可，王嘉争，等.连续髂筋膜间隙阻滞对老年髋部骨折患者炎症反应及术后谵妄的影响［J］.麻醉安全与质控，2024，6（2）：70-74.
［42］ Mo Y， Wang C， Yin D， et al. Efficacy of dexamethasone in reducing pain and inflammation and accelerating total hip arthroplasty postoperative recovery： a randomized controlled trial［J］.J Perianesth Nurs， 2024，39（4）：589-595.
［43］ Jötten L， Steinkraus KC， Traub B， et al. Impact of perioperative steroid administration in patients undergoing elective liver resection： meta-analysis［J］.BJS Open， 2022，6（6）：zrac139.
［44］ Wu Z， Li H， Liao K， et al. Association between dexamethasone and delirium in critically Ill patients： a retrospective cohort study of a large clinical database［J］.J Surg Res， 2021，263：89-101.
［45］ Onyeakazi UM， Columb MO， Rosalind A， et al. Melatonin treatment has consistent but transient beneficial effects on sleep measures and pain in patients with severe chronic pain： the DREAM-CP randomised controlled trial［J］.Br J Anaesth， 2024，132（4）：725-734.
［46］ Chen L， Cao J， Cao D， et al. Protective effect of dexmedetomidine against diabetic hyperglycemia-exacerbated cerebral ischemia/reperfusion injury： an in vivo and in vitro study［J］.Life Sci， 2019，235：116553.
［47］ Li LQ， Wang C， Fang MD， et al. Effects of dexamethasone on post-operative cognitive dysfunction and delirium in adults following general anaesthesia： a meta-analysis of randomised controlled trials［J］.BMC Anesthesiol， 2019，19（1）：113.
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