Effects of perioperative interventions for preventing postoperative delirium: A protocol for systematic review and meta-analysis of randomized controlled trials.
Effects of perioperative interventions for preventing postoperative delirium: A protocol for systematic review and meta-analysis of randomized controlled trials.
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DOI：
10.1097/md.0000000000026662
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发表时间：
2021-07-23
期刊：
影响因子：
1.6
通讯作者：
Wu Q
中科院分区：
文献类型：
--
作者：
Li X;Wang Y;Liu J;Xiong Y;Chen S;Han J;Xie W;Wu Q
术后谵妄（POD）不仅增加了医疗负担，而且对患者预后有不利影响。虽然一些谵妄病例可以通过早期干预来避免，但没有明确的证据表明这些措施是否可以有效预防特定患者群体的POD。本荟萃分析旨在比较管理POD的现有预防措施的有效性和安全性。检索PubMed、奥维德（Embase和MEDLINE）、Web of Science和科克伦图书馆数据库中2020年1月之前发表的文章。根据纳入和排除标准选择相关随机对照试验（RCT）。分别根据预先设计的数据提取表和评分系统进行数据提取和方法学质量评估。根据主要结局（如POD发生率）和次要结局（如谵妄持续时间和重症监护室和住院时间）对干预措施进行比较。本研究纳入了63项RCT，涵盖了手术、麻醉、镇痛药、术中血糖控制、胆碱酯酶抑制剂、抗惊厥药物、抗精神病药物、睡眠节律调节和多模式护理等干预措施。在术中使用脑电双频指数监测麻醉深度的4项试验中，POD的发生率较低（P <.0001）。 两项研究表明，补充镇痛是有用的谵妄预防（P = 0.002）。 17项研究表明，围手术期使用α2-肾上腺素能受体激动剂镇静可预防POD（P =.0006）。 6项研究表明，典型和非典型抗精神病药物均能降低POD的发生率（P =.002）。 在6项研究中，围手术期的多模式护理有效降低了POD（P <.00001）。 此外，这些预防措施可以减少谵妄的持续时间，以及非心脏手术患者的总住院时间和术后住院时间。对于接受心脏手术的患者，有效的预防只能减少重症监护室的住院时间。术中监测脑电双频指数、辅助镇痛、α2-肾上腺素能受体激动剂、抗精神病药物和多模式护理有助于有效预防POD。然而，需要更大，高质量的随机对照试验来验证这些发现，并开发更多的干预措施和药物来预防术后谵妄。
Postoperative delirium (POD) not only increases the medical burden but also adversely affects patient prognosis. Although some cases of delirium can be avoided by early intervention, there is no clear evidence indicating whether any of these measures can effectively prevent POD in specific patient groups. The aim of this meta-analysis was to compare the efficacy and safety of the existing preventive measures for managing POD. The PubMed, OVID (Embase and MEDLINE), Web of Science, and the Cochrane Library databases were searched for articles published before January 2020. The relevant randomized controlled trials (RCTs) were selected based on the inclusion and exclusion criteria. Data extraction and methodological quality assessment were performed according to a predesigned data extraction form and scoring system, respectively. The interventions were compared on the basis of the primary outcome like incidence of POD, and secondary outcomes like duration of delirium and the length of intensive care unit and hospital stay. Sixty-three RCTs were included in the study, covering interventions like surgery, anesthesia, analgesics, intraoperative blood glucose control, cholinesterase inhibitors, anticonvulsant drugs, antipsychotic drugs, sleep rhythmic regulation, and multi-modal nursing. The occurrence of POD was low in 4 trials that monitored the depth of anesthesia with bispectral index during the operation (P < .0001). Two studies showed that supplementary analgesia was useful for delirium prevention (P = .002). Seventeen studies showed that perioperative sedation with α2-adrenergic receptor agonists prevented POD (P = .0006). Six studies showed that both typical and atypical antipsychotic drugs can reduce the incidence of POD (P = .002). Multimodal nursing during the perioperative period effectively reduced POD in 6 studies (P < .00001). Furthermore, these preventive measures can reduce the duration of delirium, as well as the total and postoperative length of hospitalized stay for non-cardiac surgery patients. For patients undergoing cardiac surgery, effective prevention can only reduce the length of intensive care unit stay. Measures including intraoperative monitoring of bispectral index, supplemental analgesia, α2-adrenergic receptor agonists, antipsychotic drugs, and multimodal care are helpful to prevent POD effectively. However, larger, high-quality RCTs are needed to verify these findings and develop more interventions and drugs for preventing postoperative delirium.