冠状动脉旁路移植术后谵妄危险因素的Meta分析

Risk factors for delirium after Coronary Artery Bypass Grafting:a Meta-analysis

目的:明确冠状动脉旁路移植术(CABG)术后患者发生谵妄的危险因素。方法:计算机检索CABG术后发生谵妄危险因素的文献,检索时限为2010年1月1日至2021年5月31日。经文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果:共纳入19篇文献,患者因素中年龄[OR=2.42,95%CI(1.66~3.52)]、认知障碍[OR=5.70,95%CI(3.78~8.59)]、抑郁[OR=3.76,95%CI(2.75~5.13)]、营养不良[OR=2.56,95%CI(1.60~4.11)],治疗因素中机械通气[OR=2.59,95%CI(2.31~2.89)]、体外循环[OR=2.45,95%CI(1.58~3.80)]、ICU观察时间[OR=2.96,95%CI(2.50~3.49)]、镇静药物使用[OR=6.82,95%CI(4.11~11.34)],疾病因素中房颤[OR=2.19,95%CI(1.70~2.83)]、脑血管疾病[OR=2.48,95%CI(1.76~3.49)]、糖尿病[OR=4.20,95%CI(2.71~6.48)]、贫血[OR=2.95,95%CI(1.60~5.44)]、合并症[OR=3.08,95%CI(2.21~4.31)]及肌酐升高[OR=2.28,95%CI(1.56~3.34)]是CABG术后谵妄发生的危险因素。结论:各研究在样本量、病例选择等方面存在异质性,后期尚需更多高质量的研究进行验证,为开发针对CABG术后谵妄的临床风险筛查工具提供依据。

Objective:To identify risk factors for delirium in patients with Coronary Artery Bypass Grafting(CABG).Methods:Computer retrieval of literature on the risk factors of delirium after CABG.The retrieval time limit is January 1,2010 to May 31,2021.After literature screenning,data extraction and quality evaluation,RevMan 5.3 software was used for Meta analysis.Results:A total of 19 articles were included.The statistically significant risk factors included age[OR=2.42,95%CI(1.66-3.52)],cognitive impairment[OR=5.70,95%CI(3.78-8.59)],depression[OR=3.76,95%CI(2.75-5.13)],malnutrition[OR=2.56,95%CI(1.60-4.11)],mechanical ventilation[OR=2.59,95%CI(2.31-2.89)],cardiopulmonary bypass[OR=2.45,95%CI(1.58-3.80)],observation time in ICU[OR=2.96,95%CI(2.50-3.49)],cerebrovascular diseases[OR=2.48,95%CI(1.76-3.49)],diabetes[OR=4.20,95%CI(2.71-6.48)],anemia[OR=2.95,95%CI(1.60-5.44)],complications[OR=3.08,95%CI(2.21-4.31)]and increased creatinine[OR=2.28,95%CI(1.56-3.34)].Conclusion:There is heterogeneity in sample size,case selection and other aspects among different studies,which needs to be verified by more high-quality studies in the later stage to provide a basis for the development of clinical risk screening tools for postoperative delirium in CABG.