地塞米松对全麻后成年人术后认知功能障碍和谵妄的影响：一项随机对照试验的荟萃分析。
Effects of dexamethasone on post-operative cognitive dysfunction and delirium in adults following general anaesthesia: a meta-analysis of randomised controlled trials.
机构信息
Department of Anesthesiology, Jilin University Second Hospital, No. 218 Ziqiang street, Changchun, Jilin, 130021, People's Republic of China.
出版信息
BMC Anesthesiol. 2019 Jun 29;19(1):113. doi: 10.1186/s12871-019-0783-x.
BACKGROUND
Several studies have investigated the effects of dexamethasone on post-operative cognitive dysfunction (POCD) or post-operative delirium (POD); however, their conclusions have been inconsistent. Thus, we conducted a meta-analysis to determine the effects of dexamethasone on POCD and POD in adults following general anaesthesia.
METHODS
The Cochrane Central Register of Controlled Trials (2018, Issue 11 of 12) in the Cochrane Library (searched 17 November 2018), MEDLINE OvidSP (1946 to 16 November 2018) and Embase OvidSP (1974 to 16 November 2018) were searched for randomised controlled trials that evaluated the incidence of POCD and POD following dexamethasone administration in adults (age ≥ 18 years) under general anaesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations framework to assess the quality of the evidence.
RESULTS
Five studies were included (three studies with 855 participants in the dexamethasone group and 538 participants in the placebo group for the incidence of POCD, and two studies with 410 participants in the dexamethasone group and 420 participants in the placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD 30 days after surgery (RR [relative risk] 1.00; 95% CI [confidence interval: 0.51, 1.96], P = 1.00, I = 77%) or the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I = 0%). However, both analyses had some limitations because of limited evidence and clinical heterogeneity, and we considered the quality of the evidence for the post-operative incidence of POCD and POD to be very low.
CONCLUSIONS
This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative preventive strategies for POCD and POD, as well as a better understanding of the pathophysiology of those complex syndromes, are still needed to make progress in this field.
TRIAL REGISTRATIONR
This study is registered with PROSPERO, 23 October 2018, number CRD42018114552. Available from https://www.crd.york.ac.uk/PROSPERO/#recordDetails .
背景
多项研究调查了地塞米松对术后认知功能障碍（POCD）或术后谵妄（POD）的影响，但结论并不一致。因此，我们进行了一项荟萃分析，以确定地塞米松对全麻后成年人 POCD 和 POD 的影响。
方法
检索 Cochrane 图书馆 2018 年 12 月第 11 期（11 月 17 日检索）、MEDLINE OvidSP（1946 年至 11 月 16 日）和 Embase OvidSP（1974 年至 11 月 16 日）中的随机对照试验，评估地塞米松对成人（年龄≥18 岁）全麻后 POCD 和 POD 发生率的影响。我们使用推荐分级评估、制定与评价（GRADE）框架来评估证据质量。
结果
纳入 5 项研究（3 项研究中，地塞米松组 855 例，安慰剂组 538 例，术后 30 天 POCD 发生率；2 项研究中，地塞米松组 410 例，安慰剂组 420 例，POD 发生率）。与安慰剂组相比，地塞米松组术后 30 天 POCD 发生率（RR 1.00；95%CI[0.51，1.96]，P=1.00，I=77%）或 POD 发生率（RR 0.96；95%CI[0.68，1.35]，P=0.80，I=0%）差异均无统计学意义。但由于证据有限和临床异质性，这两种分析均存在一定局限性，我们认为术后 POCD 和 POD 发生率的证据质量非常低。
结论
本荟萃分析显示，预防性地塞米松并不能降低 POCD 和 POD 的发生率。仍需试验替代 POCD 和 POD 的预防策略，并更好地了解这些复杂综合征的病理生理学，以在该领域取得进展。
试验注册
本研究于 2018 年 10 月 23 日在 PROSPERO 注册，编号为 CRD42018114552。可在 https://www.crd.york.ac.uk/PROSPERO/#recordDetails 获得。
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