目的综合评价非药物干预对心脏大血管手术患者术后谵妄的影响,为选择最佳干预措施提供参考。方法计算机检索中国生物医学文献服务系统、中国知网、万方数据库、维普数据库、PubMed、Web of Science、Cochrane Library、Embase和Scopus...目的综合评价非药物干预对心脏大血管手术患者术后谵妄的影响,为选择最佳干预措施提供参考。方法计算机检索中国生物医学文献服务系统、中国知网、万方数据库、维普数据库、PubMed、Web of Science、Cochrane Library、Embase和Scopus数据库,检索时限为建库至2022年3月,收集不同非药物干预对心脏大血管手术患者术后谵妄影响的随机对照研究。由2名研究者独立筛选文献、提取资料并进行文献质量评价,运用Stata 16.0软件进行网状Meta分析。结果共纳入16项研究,总样本量为2011例。网状Meta分析结果显示,针对性心理干预(OR=10.15,P<0.05)对患者术后谵妄的防治效果最佳,其次分别为早期活动、音乐疗法、ABCDE集束化护理措施、目标性镇静镇痛结合早期活动(OR=3.48~5.42,均P<0.05)等。结论针对性心理干预和早期运动分别为最佳的多组分和单一非药物干预措施,多组分非药物干预相比单一干预措施对预防心脏大血管手术患者术后谵妄更有优势。未来可根据循证证据制订策略精准的多组分非药物干预方案,以降低患者术后谵妄发生率。展开更多
We report on the incidence of adverse cardiac events in 350 patients who underwent noncardiac surgery within 2 months of successful balloon angioplasty(BA) at our institution between 1988 and 2001. Three patients died...We report on the incidence of adverse cardiac events in 350 patients who underwent noncardiac surgery within 2 months of successful balloon angioplasty(BA) at our institution between 1988 and 2001. Three patients died perioperatively(n=1) or had myocardial infarction(n=2)(0.9%, 95%confidence interval[CI] 0.2%to 2.5%), which is a lower incidence than that reported for patients undergoing noncardiac surgery after stenting(3.9%to 32%). One patient died, and 2 had a nonfatal myocardial infarction. All 3(1.6%, 95%CI 0.3%to 4.6%)were among the 188 patients who underwent surgery within 2 weeks of BA. Repeat target vessel revascularization was performed in 10 patients(2.9%, 95%CI 1.4%to 5.2%): in 3(1.6%, 95%CI 0.3%to 4.6%) of 188 patients who underwent surgery within 2 weeks of BA and in 7(5.1%, 95%CI 2.1%to 10.2%) of 138 patients who underwent surgery within 3 to 7 weeks of BA. Therefore, in patients in whom percutaneous coronary revascularization is required before noncardiac surgery, BA appears to be safe, especially in patients who need to undergo surgery early after percutaneous coronary intervention.展开更多
文摘目的综合评价非药物干预对心脏大血管手术患者术后谵妄的影响,为选择最佳干预措施提供参考。方法计算机检索中国生物医学文献服务系统、中国知网、万方数据库、维普数据库、PubMed、Web of Science、Cochrane Library、Embase和Scopus数据库,检索时限为建库至2022年3月,收集不同非药物干预对心脏大血管手术患者术后谵妄影响的随机对照研究。由2名研究者独立筛选文献、提取资料并进行文献质量评价,运用Stata 16.0软件进行网状Meta分析。结果共纳入16项研究,总样本量为2011例。网状Meta分析结果显示,针对性心理干预(OR=10.15,P<0.05)对患者术后谵妄的防治效果最佳,其次分别为早期活动、音乐疗法、ABCDE集束化护理措施、目标性镇静镇痛结合早期活动(OR=3.48~5.42,均P<0.05)等。结论针对性心理干预和早期运动分别为最佳的多组分和单一非药物干预措施,多组分非药物干预相比单一干预措施对预防心脏大血管手术患者术后谵妄更有优势。未来可根据循证证据制订策略精准的多组分非药物干预方案,以降低患者术后谵妄发生率。
文摘We report on the incidence of adverse cardiac events in 350 patients who underwent noncardiac surgery within 2 months of successful balloon angioplasty(BA) at our institution between 1988 and 2001. Three patients died perioperatively(n=1) or had myocardial infarction(n=2)(0.9%, 95%confidence interval[CI] 0.2%to 2.5%), which is a lower incidence than that reported for patients undergoing noncardiac surgery after stenting(3.9%to 32%). One patient died, and 2 had a nonfatal myocardial infarction. All 3(1.6%, 95%CI 0.3%to 4.6%)were among the 188 patients who underwent surgery within 2 weeks of BA. Repeat target vessel revascularization was performed in 10 patients(2.9%, 95%CI 1.4%to 5.2%): in 3(1.6%, 95%CI 0.3%to 4.6%) of 188 patients who underwent surgery within 2 weeks of BA and in 7(5.1%, 95%CI 2.1%to 10.2%) of 138 patients who underwent surgery within 3 to 7 weeks of BA. Therefore, in patients in whom percutaneous coronary revascularization is required before noncardiac surgery, BA appears to be safe, especially in patients who need to undergo surgery early after percutaneous coronary intervention.