Stanford A型主动脉夹层患者术后谵妄预防及管理的最佳证据总结

Best evidence summary for the prevention and management of postoperative delirium in patients with Stanford type A aortic dissection

目的检索、评价并综整国内外有关Stanford A型主动脉夹层患者术后谵妄预防及管理的最佳证据。方法参照“6S”证据等级金字塔,系统检索UpToDate、BMJ Best Practice、加拿大安大略注册护士协会网、国际指南协作网、英国国家医疗保健优化研究所、美国国立指南网、苏格兰学院间指南网、WHO、医脉通、JBI EBP、ACP Journal Club、Cochrane、PubMed、Web of Science、Embase、中国生物医学文献数据库、万方、中国知网、维普等网站关于Stanford A型主动脉夹层患者术后谵妄预防及管理的证据,包括临床决策、临床实践指南、系统评价、Meta分析和专家共识,检索时限从各数据库建库至2023年4月。课题组成员对文献进行筛选、质量评价、证据提取及整合,最后评定证据级别。结果共纳入临床决策1篇,临床实践指南7篇,Meta分析2篇,专家共识4篇。通过综整证据,形成Stanford A型主动脉夹层患者术后谵妄预防及管理的最佳证据总结,主要包括谵妄的管理原则、术前神经系统检查、术中脑保护、术后谵妄的评估与监测、识别谵妄的危险因素、谵妄危险因素的预防、谵妄的非药物治疗、谵妄的药物治疗、出院健康随访9个方面,形成了29条推荐意见。结论本研究总结了Stanford A型主动脉夹层患者术后谵妄预防及管理的最佳证据,涵盖谵妄的管理原则、术前神经系统检查、术中脑保护、术后谵妄的评估与监测、识别谵妄的危险因素、谵妄危险因素的预防、谵妄的非药物治疗、谵妄的药物治疗、出院健康随访9个方面,医疗机构应结合临床实际情景及患者意愿,审慎地将证据应用于临床,以期保障Stanford A型主动脉夹层患者围术期安全,促进康复。

Objective To retrieve,evaluate,and integrate the best evidence related to the prevention and management of postoperative delirium in patients with Stanford type A aortic dissection at home and abroad.Methods Referring to the“6S”evidence level pyramid,a thorough search of the literature was conducted to find evidence on the prevention and treatment of postoperative delirium in Stanford type A aortic dissection patients.The database mainly included UpToDate,BMJ Best Practice,Registered Nurses Association of Ontario,Guidelines International Network,National Institute for Health and Care Excellence of U.K.,National Guideline Clearinghouse of U.S.,Scottish Intercollegiate Guidelines Network,WHO,Medlive,JBI EBP,ACP Journal Club,Cochrane,PubMed,Web of Science,Embase,SinoMed,Wanfang,CNKI,VIP,etc.Literature types included clinical decision-making,clinical practice guidelines,systematic reviews,Meta-analysis and expert consensus.The search period was from the establishment of various databases until April 2023.The members of the research group conducted literature screening,quality evaluation,evidence extraction,and integration,and finally evaluated the level of evidence.Results One clinical decision,seven clinical practice guidelines,two Meta-analyses,and four expert consensuses were included.Through the synthesis of evidence,the best evidence summary for the prevention and management of postoperative delirium in Stanford type A aortic dissection patients was formed,mainly including the management principles of delirium,preoperative neurological examination,intraoperative brain protection,evaluation and monitoring of postoperative delirium,identification of delirium risk factors,prevention of delirium risk factors,non-pharmacological treatment of delirium,pharmacological treatment of delirium,and health follow-up after discharge.A total of 29 recommendations were formed.Conclusion This study summarizes the best evidence for the prevention and management of postoperative delirium in patients with Stanford type A aortic dissection,including the management principles of delirium,preoperative neurological examination,intraoperative brain protection,evaluation and monitoring of postoperative delirium,identification of delirium risk factors,prevention of delirium risk factors,non-pharmacological treatment of delirium,pharmacological treatment of delirium,and health follow-up after discharge.Medical institutions should carefully apply the evidence to clinical settings and patient preferences,in order to ensure the perioperative safety of Stanford type A aortic dissection patients and promote rehabilitation.