术中局部脑氧饱和度监测对非心脏手术老年患者围术期神经认知障碍影响的meta分析

Effect of intraoperative regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders in elderly patients undergoing non-cardiac surgery: a meta-analysis

目的:采用meta分析方法评价术中局部脑氧饱和度(rSO_(2))监测对非心脏手术老年患者围术期神经认知障碍(PND)的影响。方法:通过计算机检索中国知网、万方数据库、中国生物医学文献数据库、维普、PubMed、Cochrane Library、Embase、Web of science数据库,纳入术中rSO_(2)监测对非心脏手术老年患者PND影响的随机对照试验(RCT),检索时间为建库至2022年10月。主要结局指标为PND(术后1~7 d)的发生率,次要结局指标为术中rSO_(2)最小值(rSO_(2min))、术中rSO_(2)平均值(rSO_(2mean))、rSO_(2)较基础值(rSO_(2)baseline)下降的最大百分比(rSO_(2)%max)和蒙特利尔认知评估量表评分。对符合纳入标准的文献进行质量评价和数据提取,采用RevMan 5.4软件进行meta分析。结果:纳入13项RCT研究,1134例患者,其中试验组(rSO_(2)监测下麻醉)557例,对照组577例。meta分析结果显示,试验组PND发生率低于对照组(RR=0.32,95%CI 0.25~0.41,P<0.001);试验组术中rSO_(2min)高于对照组(MD=7.46,95%CI 5.05~9.86,P<0.001),术中rSO_(2mean)高于对照组(MD=5.49,95%CI 3.97~7.02,P<0.001),术中rSO_(2)%max低于对照组(MD=-6.55,95%CI-9.03~-4.07,P<0.001),术后蒙特利尔认知评估量表评分高于对照组(MD=1.37,95%CI 0.74~1.99,P<0.001)。结论:术中应用rSO_(2)监测可减少非心脏手术老年患者PND的发生。

Objective To systematically review and evaluate the effect of intraoperative regional cerebral oxygen saturation(rSO_(2))monitoring on perioperative neurocognitive disorders(PNDs)in elderly patients undergoing non-cardiac surgery.MethodsChina National Knowledge Infrastructure,Wanfang Database,China Biomedical Literature Database,China Science and Technology Journal Database,PubMed,Cochrane Library,Embase and Web of Science databases were searched from inception to October 2022 for randomized controlled trials involving the effects of intraoperative rSO_(2) monitoring on PND in elderly patients underwent non-cardiac surgery.The primary outcome measure was the incidence of PND(1-7 days after surgery),and secondary outcome measures were intraoperative minimum rSO_(2)(rSO_(2min)),intraoperative mean rSO_(2)(rSO_(2mean)),maximum percentage of decrease(rSO_(2)%max)in rSO_(2) from baseline(rSO_(2)baseline),and the Montreal Cognitive Assessment Scale was used to evaluate the quality of references that met the inclusion criteria,and data were extracted for meta-analysis using RevMan5.4 software.ResultsThirteen randomized controlled trials were enrolled,involving 1134 patients with 557 patients in experimental group(anesthesia under rSO_(2) monitoring)and 577 patients in control group.The results of meta-analysis showed that the incidence of PND was significantly lower in experimental group than in control group(RR=0.32,95%confidence interval[CI]0.25-0.41,P<0.001),the intraoperative rSO_(2min) was significantly higher in experimental group than in control group(MD=7.46,95%CI 5.05-9.86,P<0.001),and the intraoperative rSO_(2mean) was significantly higher in experimental group than in control group(MD=5.49,95%CI 3.97-7.02,P<0.001),the intraoperative rSO_(2)%max was significantly lower in experimental group than in control group(MD=-6.55,95%CI-9.03--4.07,P<0.001),and the postoperative Montreal Cognitive Assessment Scale score was significantly higher in experimental group than in control group(MD=1.37,95%CI 0.74-1.99,P<0.001).ConclusionsIntraoperative application of rSO_(2) monitoring can reduce the occurrence of PND in elderly patients undergoing non-cardiac surgery.