围术期麻醉药降低成人非心脏及颅脑手术术后谵妄疗效及安全性的网状Meta分析

Efficacy and safety of perioperative anesthetics on reducing postoperative delirium after non-cardiac and non-craniocerebral surgery in adults:a network Meta-analysis

目的采用网状Meta分析评价围术期麻醉药降低成人非心脏及颅脑手术术后谵妄的疗效和安全性。方法检索中国知网、万方、维普、PubMed、Web of Science、Cochrane Library数据库中围术期麻醉药降低成人非心脏及颅脑手术术后谵妄的临床随机平行对照试验(RCTs),应用Rev Man 5.3软件进行纳入研究的质量评价,运用Stata16.0软件进行Meta分析。结果最终纳入44项RCTs,共7628例患者。直接比较显示,右美托咪定组术后谵妄发生率是安慰剂组的0.48倍(RR=0.48,95%CI:0.40~0.58,P<0.001),是丙泊酚组的0.55倍(RR=0.55,95%CI:0.38~0.78,P=0.001),是咪达唑仑组的0.25倍(RR=0.25,95%CI:0.17~0.36,P<0.001),这与网状比较的结果是一致的。概率排序图显示,右美托咪定降低术后谵妄的疗效最佳。不良反应方面,右美托咪定组低血压和心动过缓的发生率分别是安慰剂的1.21倍(RR=1.21,95%CI:1.09~1.34,P<0.001)和1.47倍(RR=1.47,95%CI:1.25~1.72,P<0.001)。结论右美托咪定能降低成人非心脏及颅脑手术术后谵妄的发生风险,但会增加低血压和心动过缓的发生。

Objective Network Meta-analysis was used to evaluate the efficacy and safety of perioperative anesthetics in reducing delirium after non-cardiac and non-craniocerebral surgery in adults.Methods The randomized controlled trial(RCT)literatures of perioperative anesthetics in reducing delirium undergoing non-cardiac and non-craniocerebral surgery from the database of CNKI,Wanfang,VIP,PubMed,Web of Science and Cochrane Library were selected.The quality of the included literatures were evaluated with RevMan 5.3 software.Stata16.0 software was used for the comparison of network Meta-analysis.Results A total of 44 RCTs studies and 7628 patients were included.Direct comparisons showed that compared with placebo(RR=0.48,95%CI:0.40-0.58,P<0.001),Propofol(RR=0.55,95%CI:0.38-0.78,P=0.001)and Midazolam(RR=0.25,95%CI:0.17-0.36,P<0.001),Dexmedetomidine significantly reduced the incidence of postoperative delirium,which were consistent with network Meta-analysis.In terms of probability ranking,Dexmedetomidine seemed to be the best agent among all the treatments.In terms of adverse reactions,compared with placebo,Dexmedetomidine was associated with a higher incidence of perioperative hypotension(RR=1.21,95%CI:1.09-1.34,P<0.001)and bradycardia(RR=1.47,95%CI:1.25-1.72,P<0.001).Conclusion Dexmedetomidine can significantly reduce the risk of delirium after non-cardiac and non-craniocerebral surgery in adults.However,it has a higher risk of perioperative hypotension and bradycardia.