头颈部手术后谵妄危险因素的meta分析

Meta-analysis of risk factors associated with postoperative delirium after head and neck surgery

目的:分析头颈部手术后谵妄危险因素,为临床有效预防术后谵妄提供依据。方法:通过计算机检索Pub Med、Cochrane library、EMBASE、ISI Web of Knowledge、Google scholar、CNKI数据库、维普数据库和万方数据库,查找关于头颈部手术后谵妄危险因素的文献,截止日期为2014年1月。采用Rev Man5.2软件进行统计学分析。结果:共纳入7篇关于头颈部手术患者术后谵妄危险因素的病例对照研究,共有1664例患者行头颈部手术,谵妄组237例,非谵妄组1427例。研究结果表明,年龄(WMD:5.70,95%CI:1.96-9.43,P<0.001)、性别(OR:1.51,95%CI:1.07-2.12,P<0.05)、独居(OR:2.22,95%CI:1.42-3.48,P<0.001)、术前精神疾病(OR:2.57,95%CI:1.60-4.15,P<0.05)、酗酒(OR:1.74,95%CI:1.79-2.54,P<0.05)及手术麻醉时间(WMD:63.93,95%CI:9.47-118.38,P<0.05)等6项为头颈部手术患者术后谵妄相关因素;而与根治性颈淋巴清扫术、游离皮瓣修复、气管切开、术后制动等因素无显著相关性(P>0.05)。结论:患者年龄、性别、独居、术前精神疾病、酗酒及手术麻醉时间等6项为头颈部手术患者术后谵妄的危险因素。

PURPOSE： To explore the risk factors associated with postoperative delirium after head and neck surgery.METHODS： A systematic search of MEDLINE, Cochrane Library, EMBASE, ISI Web of Knowledge, Google scholar,CNKI, Wan Fang, VIP databases, up to January 2014, was performed to identify articles about risk factors for postoperative delirium after head and neck surgery. Meta-analysis was performed by Rev Man5.2. RESULTS： Seven studies regarding the risk factors associated with postoperative delirium after head and neck surgery were collected, involving 1664 cases in total, two hundred thirty-seven cases in delirium group and 1427 cases in non-delirium group. Meta-analysis showed that age（WMD：5.70, 95% CI：1.96-9.43, P〈0.001）, gender（OR：1.51, 95% CI：1.07-2.12, P〈0.05）, solitude（OR：2.22, 95% CI：1.42-3.48, P〈0.001）, preoperative mental disease（OR：2.57, 95% CI：1.60-4.15, P〈0.05）, alcohol abuse（OR：1.74, 95% CI：1.79-2.54, P 〈0.05） and time of operation and anesthesia（WMD：63.93, 95% CI：9.47-118.38, P 〈0.05） were related to postoperative delirium after head and neck surgery. There was no significant difference in radical neck dissection, free flap reconstruction, tracheotomy and restriction of mobility between patients with and without postoperative delirium（ P〉0.05）.CONCLUSIONS： Age, gender, solitude, preoperative mental disease, alcohol abuse and time of operation and anesthesia are risk factors for postoperative delirium after head and neck surgery.