Mechanisms underlying the preventive and therapeutic effects of dexmedetomidine on postoperative delirium following cardiac valve replacement under cardiopulmonary bypass

CHEN Jing; DU Yuan-lin; CHEN Wei; WEI Qin; CHEN Wei; SONG Yi; YAN Hong; MAO Qing-xiang; LI Tao; HU Yi

doi:10.11659/jjssx.05E026058

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Mechanisms underlying the preventive and therapeutic effects of dexmedetomidine on postoperative delirium following cardiac valve replacement under cardiopulmonary bypass

Clinical Research | 更新时间：2026-10-26

- Mechanisms underlying the preventive and therapeutic effects of dexmedetomidine on postoperative delirium following cardiac valve replacement under cardiopulmonary bypass
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 35, Issue 10, Pages: 879-884(2026)
- 作者机构：
  
  1.陆军特色医学中心麻醉科，重庆 400042
  2.陆军特色医学中心心血管外科，重庆 400042
  3.野战外科研究所战伤休克与输血研究室/创伤、烧伤与复合伤国家重点实验室，重庆 400042
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.05E026058
  CLC： R614
- Received：12 May 2026，
  
  Revised：2026-10-05，
  
  Accepted：22 July 2026，
  
  Published：25 October 2026
- 稿件说明：
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陈婧,杜远琳,陈薇等.右美托咪定对体外循环心脏瓣膜置换术后谵妄的防治机制研究[J].局解手术学杂志,2026,35(10):879-884.

CHEN Jing,DU Yuan-lin,CHEN Wei,et al.Mechanisms underlying the preventive and therapeutic effects of dexmedetomidine on postoperative delirium following cardiac valve replacement under cardiopulmonary bypass[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(10):879-884.
陈婧,杜远琳,陈薇等.右美托咪定对体外循环心脏瓣膜置换术后谵妄的防治机制研究[J].局解手术学杂志,2026,35(10):879-884. DOI： 10.11659/jjssx.05E026058.

CHEN Jing,DU Yuan-lin,CHEN Wei,et al.Mechanisms underlying the preventive and therapeutic effects of dexmedetomidine on postoperative delirium following cardiac valve replacement under cardiopulmonary bypass[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(10):879-884. DOI： 10.11659/jjssx.05E026058.

摘要

目的

从代谢角度探索右美托咪定（DEX）调控术后谵妄（POD）的潜在机制，为POD的防治提供新思路。

方法

选择体外循环（CPB）下行心脏瓣膜置换术的患者60例，随机分为DEX组与对照组，每组30例。术后24 h采集2组患者的外周静脉血进行代谢组学分析，筛选差异代谢物及代谢通路。采用随机森林算法筛选DEX干预POD的关键生物标志物。

结果

DEX组术后24 h的POD发生率低于对照组（13.3%

.36.7%），差异有统计学意义（

0.05）。代谢组学分析共检出50种差异代谢物，涉及组氨酸代谢、鞘脂代谢与信号通路等20条代谢通路。采用随机森林机器算法筛选出的5种关键差异代谢物为α-KIV、m¹A、SM(d18:1/20:0)、PAGln和DA3S。

结论

DEX可调控多种代谢物水平，其中可能主要通过上调m¹A、DA3S、PAGln，下调α-KIV、SM(d18:1/20:0)及相应代谢通路，发挥对CPB下心脏手术患者POD的防治作用。

Abstract

Objective

To investigate the potential mechanisms by which dexmedetomidine （DEX） regulates postoperative delirium （POD） from a metabolic perspective，thereby providing new insights into the prevention and treatment of POD.

Methods

Sixty patients undergoing cardiac valve replacement under cardiopulmonary bypass （CPB） were randomly assigned to the DEX group and the control group，with 30 patients in each group. Metabolomic analysis was performed on peripheral venous blood samples collected 24 hours postoperatively from both groups to identify differential metabolites and metabolic pathways. A random forest algorithm was employed to identify key biomarkers associated with DEX intervention in POD.

Results

The incidence of POD at 24 hours after surgery in the DEX group was lower than that in the control group （13.3%

.36.7%）， and the difference was statistically significant（

0.05）.A total of 50 differential metabolites were identified by metabolomic analysis， involving 20 metabolic pathways such as histidine metabolism， sphingolipid metabolism and signaling pathways.Five key differential metabolites screened by the random forest machine algorithm were α-KIV， m¹A， SM（d18：1/20：0）， PAGln and DA3S.

Conclusion

DEX can regulate the levels of various metabolites. It may exert preventive and therapeutic effects on POD in patients undergoing cardiac surgery under CPB mainly by upregulating m¹A，DA3S and PAGln，downregulating α-KIV and SM（d18：1/20：0）， and modulating the corresponding metabolic pathways.

关键词

Keywords

references

Patel M ， Onwochei DN ， Desai N . Influence of perioperative dexmedetomidine on the incidence of postoperative delirium in adult patients undergoing cardiac surgery ［J］. Br J Anaesth ， 2022 ， 129 （ 1 ）： 67 - 83 . doi： 10.1016/j.bja.2021.11.041 http://dx.doi.org/10.1016/j.bja.2021.11.041 .

Yang T ， Velagapudi R ， Terrando N . Neuroinflammation after surgery：from mechanisms to therapeutic targets ［J］. Nat Immunol ， 2020 ， 21 （ 11 ）： 1319 - 1326 . doi： 10.1038/s41590-020-00812-1 http://dx.doi.org/10.1038/s41590-020-00812-1 .

Zhuang Y ， Xu J ， Zheng K ， et al . Research progress of postoperative cognitive dysfunction in cardiac surgery under cardiopulmonary bypass ［J］. Ibrain ， 2023 ， 10 （ 3 ）： 290 - 304 . doi： 10.1002/ibra.12123 http://dx.doi.org/10.1002/ibra.12123 .

Lu X ， Yan R ， Song S . Neurobiological mechanisms of postoperative delirium at neural molecular and cellular levels ［J］. Acad Med Health ， 2025 ， 2 （ 4 ）. doi： 10.20935/AcadMedHealth7977 http://dx.doi.org/10.20935/AcadMedHealth7977 .

3rd Bargnes V ， Oliver B ， Wang E ， et al . Taming postoperative delirium with dexmedetomidine：a review of the therapeutic agent's neuroprotective effects following surgery ［J］. Pharmaceuticals ， 2023 ， 16 （ 10 ）： 1453 . doi： 10.3390/ph16101453 http://dx.doi.org/10.3390/ph16101453 .

Zhong Y ， Ren Z ， Gao J ， et al . Dexmedetomidine for the prevention of postoperative delirium in patients undergoing cardiac surgery：a systematic review and meta-analysis with trial sequential analysis ［J］. BMC Anesthesiol ， 2025 ， 25 （ 1 ）： 408 . doi： 10.1186/s12871-025-03264-y http://dx.doi.org/10.1186/s12871-025-03264-y .

Tripp BA ， Dillon ST ， Yuan M ， et al . Targeted metabolomics analysis of postoperative delirium ［J］. Sci Rep ， 2021 ， 11 （ 1 ）： 1521 . doi： 10.1038/s41598-020-80412-z http://dx.doi.org/10.1038/s41598-020-80412-z .

Wiredu K ， Gowda P ， Rhee J ， et al . Long-chain polyunsaturated fatty acid lipid and oxylipin alterations in postoperative delirium after cardiac surgery ［J］. J Lipid Res ， 2026 ， 67 （ 1 ）： 100959 . doi： 10.1016/j.jlr.2025.100959 http://dx.doi.org/10.1016/j.jlr.2025.100959 .

Ma R ， Zhao J ， Li C ， et al . Diagnostic accuracy of the 3-minute diagnostic interview for confusion assessment method-defined delirium in delirium detection： a systematic review and meta-analysis ［J］. Age Ageing ， 2023 ， 52 （ 5 ）： afad074 . doi： 10.1093/ageing/afad074 http://dx.doi.org/10.1093/ageing/afad074 .

Zhao S ， Wang B ， Liu M ， et al . The impact of preoperative frailty on perioperative neurocognitive disorders in elderly patients：a systematic review and meta-analysis ［J］. J Res Med Sci ， 2024 ， 29 （ 1 ）： 47 . doi： 10.4103/jrms.jrms_694_23 http://dx.doi.org/10.4103/jrms.jrms_694_23 .

Shamsi T ， Janga SR ， Baskaran NU ， et al . Temporal trends and severity of postoperative delirium in cardiac surgery：insights from a systematic review and meta-analysis ［J］. J Cardiothorac Vasc Anesth ， 2025 ， 39 （ 9 ）： 2424 - 2435 . doi： 10.1053/j.jvca.2025.05.020 http://dx.doi.org/10.1053/j.jvca.2025.05.020 .

Smirnov A ， Semionov M ， Yasinski V ， et al . Post-operative delirium in elderly patients：a narrative review ［J］. Int J Mol Sci ， 2025 ， 26 （ 23 ）： 11314 . doi： 10.3390/ijms262311314 http://dx.doi.org/10.3390/ijms262311314 .

Taylor J ， Parker M ， Casey CP ， et al . Postoperative delirium and changes in the blood-brain barrier，neuroinflammation，and cerebrospinal fluid lactate：a prospective cohort study ［J］. Br J Anaesth ， 2022 ， 129 （ 2 ）： 219 - 230 . doi： 10.1016/j.bja.2022.01.005 http://dx.doi.org/10.1016/j.bja.2022.01.005 .

Meng L ， Gu T ， Yu P ， et al . The role of microglia in neuroinflammation associated with cardiopulmonary bypass ［J］. Front Cell Neurosci ， 2024 ， 18 ： 1496520 . doi： 10.3389/fncel.2024.1496520 http://dx.doi.org/10.3389/fncel.2024.1496520 .

Tao Z ， Li P ， Zhao X . Progress on the mechanisms and neuroprotective benefits of dexmedetomidine in brain diseases ［J］. Brain Behav ， 2024 ， 14 （ 11 ）： e70116 . doi： 10.1002/brb3.70116 http://dx.doi.org/10.1002/brb3.70116 .

Huang H ， Han J ， Li Y ， et al . Early serum metabolism profile of postoperative delirium in elderly patients following cardiac surgery with cardiopulmonary bypass ［J］. Front Aging Neurosci ， 2022 ， 14 ： 857902 . doi： 10.3389/fnagi.2022.857902 http://dx.doi.org/10.3389/fnagi.2022.857902 .

Ivanisenko VA ， Basov NV ， Makarova AA ， et al . Gene networks for use in metabolomic data analysis of blood plasma from patients with postoperative delirium ［J］. Vavilovskii Zhurnal Genet Selektsii ， 2023 ， 27 （ 7 ）： 768 - 775 . doi： 10.18699/VJGB-23-89 http://dx.doi.org/10.18699/VJGB-23-89 .

Lv M ， Zhang D ， Dai D ， et al . Sphingosine kinase 1/sphingosine-1-phosphate regulates the expression of interleukin-17A in activated microglia in cerebral ischemia/reperfusion ［J］. Inflamm Res ， 2016 ， 65 （ 7 ）： 551 - 562 . doi： 10.1007/s00011-016-0939-9 http://dx.doi.org/10.1007/s00011-016-0939-9 .

Patrick M ， Gu Z ， Zhang G ， et al . Metabolon formation regulates branched-chain amino acid oxidation and homeostasis ［J］. Nat Metab ， 2022 ， 4 （ 12 ）： 1775 - 1791 . doi： 10.1038/s42255-022-00689-4 http://dx.doi.org/10.1038/s42255-022-00689-4 .

Lyu C ， Wang Z ， Zhao R ， et al . Preoperative gut microbial network alterations and BCAA-Related metabolic disturbance in postoperative delirium after cardiac surgery： a prospective matched multi-omic study ［J］. Transl Psychiatry ， 2026 ， 16 （ 1 ）： 419 . doi： 10.1038/s41398-026-04161-9 http://dx.doi.org/10.1038/s41398-026-04161-9 .

Coitinho AS ， de Mello CF ， Lima TT ， et al . Pharmacological evidence that alpha-ketoisovaleric acid induces convulsions through GABAergic and glutamatergic mechanisms in rats ［J］. Brain Res ， 2001 ， 894 （ 1 ）： 68 - 73 . doi： 10.1016/s0006-8993（00）03321-7 http://dx.doi.org/10.1016/s0006-8993（00）03321-7 .

Liu Y ， Zhou J ， Li X ， et al . tRNA-m1A modification promotes T cell expansion via efficient MYC protein synthesis ［J］. Nat Immunol ， 2022 ， 23 （ 10 ）： 1433 - 1444 . doi： 10.1038/s41590-022-01301-3 http://dx.doi.org/10.1038/s41590-022-01301-3 .

Zhou ZD ， Yi LX ， Wang DQ ， et al . Role of dopamine in the pathophysiology of Parkinson's disease ［J］. Transl Neurodegener ， 2023 ， 12 （ 1 ）： 44 . doi： 10.1186/s40035-023-00378-6 http://dx.doi.org/10.1186/s40035-023-00378-6 .

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