Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing China.
Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing China.
Clin Ther. 2021 Sep;43(9):1608-1621. doi: 10.1016/j.clinthera.2021.07.021. Epub 2021 Sep 20.
Delirium is a common neurologic complication after cardiac surgery and is associated with a poor prognosis. Several studies have explored the effects of glucocorticoids on postoperative delirium (POD). However, conclusion have been inconsistent. The purpose of this systematic review and meta-analysis is to evaluate the effects of glucocorticoids on POD in adult patients undergoing cardiac surgery.
A systematic literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Library/Central, and Web of Science from inception to January 28, 2021. Randomized controlled trials evaluating the effects of perioperative glucocorticoids administration on the incidence of POD in adults (≥18 years of age) undergoing cardiac surgery were included. The primary outcome of incidence of POD was assessed using the risk ratio (RR) with a fixed-effects model. Secondary analyses included the severity or duration of delirium, mortality at 30 days, length of hospital and intensive care unit (ICU) stay, duration of mechanical ventilatory support, the incidence of myocardial injury, new atrial fibrillation, renal and respiratory failure, postoperative infection and stroke, and the level of glucose and inflammatory factors.
A total 4 trials (n = 8448 patients) were included. Glucocorticoids did not significantly reduce the incidence of POD (RR = 0.99; 95% CI, 0.86-1.14) but increased the risk of myocardial injury (RR = 1.22; 95% CI, 1.08-1.38), decreased the duration of mechanical ventilatory support (mean difference, -0.83; 95% CI, -1.32 to -0.34), and led to a tendency toward short length of ICU stay (mean difference, -0.22; 95% CI, -0.47 to -0.03). No significant differences were observed in other secondary outcomes.
The perioperative administration of glucocorticoids did not reduce the incidence of POD in adult patients undergoing cardiac surgery but might be associated with shorter duration of mechanical ventilatory support and a tendency toward a shorter length of ICU stay. Furthermore, we found that glucocorticoids may increase the rate of myocardial injury but have no effects on other clinical outcomes. International Prospective Register of Systematic Reviews identifier: CRD42021233458.
谵妄是心脏手术后常见的神经系统并发症，与预后不良有关。几项研究探讨了糖皮质激素对术后谵妄（POD）的影响。然而，结论并不一致。本系统评价和荟萃分析的目的是评估糖皮质激素对接受心脏手术的成年患者 POD 的影响。
从建库至 2021 年 1 月 28 日，通过 PubMed/MEDLINE、Embase、Cochrane 图书馆/中央、Web of Science 进行系统文献检索，纳入评估围术期糖皮质激素给药对成人（≥18 岁）心脏手术后 POD 发生率影响的随机对照试验。采用固定效应模型评估 POD 发生率的主要结局，采用风险比（RR）表示。次要分析包括谵妄的严重程度或持续时间、30 天死亡率、住院和重症监护病房（ICU）停留时间、机械通气支持时间、心肌损伤发生率、新发心房颤动、肾功能衰竭和呼吸衰竭、术后感染和卒中发生率以及血糖和炎症因子水平。
共纳入 4 项试验（n=8448 例患者）。糖皮质激素并未显著降低 POD 的发生率（RR=0.99；95%CI，0.86-1.14），但增加了心肌损伤的风险（RR=1.22；95%CI，1.08-1.38），缩短了机械通气支持的时间（平均差，-0.83；95%CI，-1.32 至-0.34），并使 ICU 停留时间有缩短的趋势（平均差，-0.22；95%CI，-0.47 至-0.03）。其他次要结局未见显著差异。
围术期给予糖皮质激素不能降低接受心脏手术的成年患者 POD 的发生率，但可能与机械通气支持时间缩短和 ICU 停留时间缩短有关。此外，我们发现糖皮质激素可能会增加心肌损伤的发生率，但对其他临床结局无影响。国际前瞻性注册系统评价号：CRD42021233458。
