肝脏切除术后患者发生谵妄危险因素的meta分析

Non-operative risk factors for postoperative delirium in patients undergoing hepatectomy:a meta-analysis

目的评价影响肝脏切除术患者术后谵妄发生的非手术危险因素。方法检索中国知网、万方、CBM、维普、PubMed和Embase数据库。检索时间为建库至2020年5月7日,检索关于肝脏切除术患者术后谵妄发生的相关因素文献。采用Revman 5.3软件合并分析提取的数据。结果共纳入5篇文献,总样本量1181例。肝脏切除术患者术后谵妄组年龄大于非谵妄组,差异有统计学意义(WMD=7.76,95%CI:4.81~10.71,P<0.05)。肝脏切除术患者术后谵妄组体重指数(BMI)和白蛋白水平低于非谵妄组(BMI:WMD=-1.19,95%CI:-2.00~-0.39;白蛋白:WMD=-0.32,95%CI:-0.42~-0.23,均P<0.05)。吸烟组较不吸烟组,酗酒组较不酗酒组患者术后谵妄发生率比较差异无统计学意义(吸烟:OR=0.55,95%CI:0.11~2.78,酗酒:OR=0.95,95%CI:0.60~1.49,均P>0.05);合并肺部疾病组较未合并肺部疾病组患者术后谵妄发生率增加(OR=3.37,95%CI:1.76~6.46,P<0.05);合并糖尿病组与未合并糖尿病组、合并心血管疾病组和未合并心血管疾病组患者术后谵妄发生率比较差异无统计学意义(糖尿病:OR=0.81,95%CI:0.52~1.27,心血管疾病:OR=0.98,95%CI:0.49~1.94,均P>0.05)。应用镇静药物组较未应用镇静药物组患者术后谵妄发生率增加(OR=4.31,95%CI:2.37~7.81,P<0.05)。结论高龄、低BMI、低白蛋白水平、合并肺部疾病和应用镇静药物是肝脏切除术患者术后谵妄发生的危险因素。

Objective To evaluate non-operative risk factors for postoperative delirium in patients undergoing hepatectomy by Meta-analysis.Methods CNKI,Wanfang,CBM,VIP,PubMed and Embase databases were searched for studies on factors affecting the occurrence of postoperative delirium in patients undergoing hepatectomy from the establishment date of databases to May 7,2020.And the extracted data were merged and analyzed by using Revman 5.3 software.Results A total of 5 articles and 1181 patients were included.Age:The age in the delirium group was older than that in the non-delirium group with statistical difference(WMD=7.76,95%CI:4.81-10.71,P<0.05).Nutritional indicators:The body mass index(BMI)and albumin level in delirium group were lower than those in non-delirium group with statistical differences(BMI:WMD=-1.19,95%CI:-2.00--0.39;albumin:WMD=-0.32,95%CI:-0.42--0.23,P<0.05).Bad life style:There were no statistical differences in incidences of postoperative delirium when comparing smoking group and non-smoking group(OR=0.55,95%CI:0.11-2.78,P>0.05).And there were no statistical differences in incidences of postoperative delirium when comparing alcohol abuse group and non-alcohol abuse group(OR=0.95,95%CI:0.60-1.49,P>0.05).Complications:The incidence of postoperative delirium in the group with pulmonary disease was higher than that in the group without pulmonary disease(OR=3.37,95%CI:1.76-6.46,P<0.05).There was were no statistical differences in the incidences of postoperative delirium between the diabetic group and the non-diabetic group,the cardiovascular disease group and the non-cardiovascular disease group(diabetes:OR=0.81,95%CI:0.52-1.27,P>0.05;cardiovascular disease:OR=0.98,95%CI:0.49-1.94,P>0.05).Sedative drugs:The incidence of postoperative delirium in the group with use of sedative drugs was higher than that in the group without use of sedative drugs(OR=4.31,95%CI:2.37-7.81,P<0.05).Conclusion Advanced age,low BMI,lower albumin level,with pulmonary disease and use of sedative drugs are risk factors for postoperative delirium in patients undergoing hepatectomy.For patients undergoing hepatectomy who have the above risk factors,we should pay attention to the occurrence of postoperative delirium,strengthen nutritional support and try to avoid the use of sedative drugs.