Liu Yong, Li Xiao-Jin, Liang Yi, Kang Yan
Department of Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China.
Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Guilin, China.
Evid Based Complement Alternat Med. 2019 Mar 14;2019:9607129. doi: 10.1155/2019/9607129. eCollection 2019.
BACKGROUND: The high prevalence of delirium among postoperative patients has increased morbidity and mortality. The kind of drug that can effectively reduce the incidence of delirium has become the focus of discussion in recent years. However, a consensus in this respect has yet to be reached. METHODS: Randomized controlled trials (RCTs) were retrieved from the PubMed, Cochrane Library, ClinicalTrials.gov, and Embase databases from their inception through October 12, 2018. We included RCTs of pharmacological prevention for postoperative delirium in adults (at least 18 years), and the Cochrane risk of bias tool was used to evaluate the methodological quality of trials. The primary outcomes were the risk ratios (RRs) of incidence of postoperative delirium, and the secondary outcomes were the RRs of mortality and adverse events in the intervention and control groups. RESULTS: Thirty-eight trials, which comprised 20302 patients and 18 different drugs, were included in the analysis. Of the 38 studies, 17 were rated as low risk with respect to methodological quality. Dexmedetomidine administration (RR 0.58, 95%CI 0.44-0.76, P<0.01) was associated with a significantly lower incidence of postoperative delirium than the control conditions. However, the findings from the studies with a low risk of bias did not show a significant difference in this beneficial effect (RR 0.64, 95%CI 0.39-1.04, P=0.07). The antipsychotic drugs olanzapine (RR 0.44, 95%CI 0.30- 0.65, P<0.01) and risperidone (RR 0.42, 95%CI 0.19-0.92, P=0.03) had promising effects, but there was a lack of sufficient evidence to obtain a definitive conclusion. The beneficial effect of other drugs, including haloperidol, methylprednisolone, dexamethasone, gabapentin, ketamine, cyproheptadine, donepezil, hypertonic saline, melatonin, nimodipine, ondansetron, pregabalin, rivastigmine, TJ-54, and tryptophan, was not proven on the basis of present evidence. CONCLUSION: Among the pharmacological prophylactic measures for postoperative delirium, dexmedetomidine, olanzapine, and risperidone showed higher efficacy than other drugs. However, more high-quality evidence is needed to confirm these results.
背景：术后患者谵妄的高发生率增加了发病率和死亡率。能有效降低谵妄发生率的药物种类已成为近年来讨论的焦点。然而，在这方面尚未达成共识。 方法：从PubMed、Cochrane图书馆、ClinicalTrials.gov和Embase数据库中检索自创建至2018年10月12日的随机对照试验（RCT）。我们纳入了针对成人（至少18岁）术后谵妄进行药物预防的RCT，并使用Cochrane偏倚风险工具评估试验的方法学质量。主要结局是术后谵妄发生率的风险比（RR），次要结局是干预组和对照组的死亡率及不良事件的RR。 结果：分析纳入了38项试验，共20302例患者及18种不同药物。在这38项研究中，17项在方法学质量方面被评为低风险。与对照情况相比，使用右美托咪定（RR 0.58，95%CI 0.44 - 0.76，P<0.01）与术后谵妄发生率显著降低相关。然而，偏倚风险低的研究结果在这种有益效果方面未显示出显著差异（RR 0.64，95%CI 0.39 - 1.04，P = 0.07）。抗精神病药物奥氮平（RR 0.44，95%CI 0.30 - 0.65，P<0.01）和利培酮（RR 0.42，95%CI 0.19 - 0.92，P = 0.03）有显著效果，但缺乏足够证据得出明确结论。包括氟哌啶醇、甲泼尼龙、地塞米松、加巴喷丁、氯胺酮、赛庚啶、多奈哌齐、高渗盐水、褪黑素、尼莫地平、昂丹司琼、普瑞巴林、卡巴拉汀、TJ - 54和色氨酸在内的其他药物的有益效果，根据现有证据尚未得到证实。 结论：在术后谵妄的药物预防措施中，右美托咪定、奥氮平和利培酮显示出比其他药物更高的疗效。然而，需要更多高质量证据来证实这些结果。
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