Stanford A型主动脉夹层术后发生谵妄影响因素的Meta分析

Meta analysis of influencing factor for postoperative delirium after Stanford type A aortic dissection

目的系统评价Stanford A型主动脉夹层(TAAD)术后发生谵妄的影响因素。方法计算机检索Pub Med、Embase、CENTRAL、Web of Science、中国知网、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库,全面收集国内外TAAD术后发生谵妄的相关研究,检索时限从建库至2022年1月,由2名评价者独立筛选文献、提取资料、评价质量,并采用Rev Man 5.3软件进行Meta分析。结果共纳入21篇文献4003例TAAD患者,其中发生谵妄1372例,发生率为17.6%~50.4%,共纳入47个影响因素。Meta分析结果显示,既往脑血管病史、深低温停循环时间延长、重症监护室(ICU)持续时间延长、机械通气时间延长、术后使用镇静镇痛药物、术后早期电解质紊乱均是TAAD术后发生谵妄的危险因素。结论既往脑血管病史、深低温停循环时间延长、ICU持续时间延长、机械通气时间延长、术后使用镇静镇痛药物、术后早期电解质紊乱均是TAAD术后发生谵妄的危险因素,可用于识别TAAD术后发生谵妄高危患者,并积极给予防治措施,从而降低谵妄发生率,促进患者康复。

Objective To systematically evaluate the influencing factor for delirium after Stanford type A aortic dissection(TAAD).Method PubMed,EMbase,CENTRAL,Web of Science,CNKI,Wanfang Data,VIP and CBM were retrieved to collect studies about delirium after TAAD published from inception to January 2022.Two authors independently assessed the studies quality,and the Meta analysis was performed by RevMan 5.3 software.Result A total of 21 studies involving 4003 cases and among them 1372 patients suffered delirium,the rate of delirium after TAAD was 17.6%-50.4%,including 47 predictive risk factors.Meta analysis showed that previous history of cerebrovascular disease,prolonged deep hypothermic circulatory arrest time,prolonged intensive care unit(ICU)indwelling time,prolonged mechanical ventilation time,postoperative use of sedation and analgesia,and early postoperative electrolyte disturbance were the risk factors for delirium after TAAD surgery.Conclusion Previous history of cerebrovascular disease,prolonged deep hypothermic circulatory arrest time,prolonged ICU indwelling time,prolonged postoperative mechanical ventilation time,postoperative use of sedation and analgesia,early postoperative electrolyte disturbance are the risk factors for delirium after TAAD,which can be used to identify high-risk patients,develop preventive strategy,treatment to reduce the incidence of delirium and promote recovery of patients.