褪黑素干预预防重症监护病房谵妄：随机对照试验的系统评价和荟萃分析。
Melatonin intervention to prevent delirium in the intensive care units: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Critical Care Medicine, The Second Affiliated Hospital, Kunming Medical University, Kunming, China.
Department of Anesthesiology, The First Affiliated Hospital, Kunming Medical University, Kunming, China.
出版信息
Front Endocrinol (Lausanne). 2023 Jul 26;14:1191830. doi: 10.3389/fendo.2023.1191830. eCollection 2023.
OBJECTIVE
To determine the preventive effect of melatonin on delirium in the intensive care units.
METHODS
We conducted a systematic search of the PubMed, Cochrane Library, Science, Embase, and CNKI databases, with retrieval dates ranging from the databases' inception to September 2022. Controlled trials on melatonin and placebo for preventing delirium in the intensive care units were included. The meta-analysis was performed using Review Manager software (version 5.3) and Stata software (version 14.0).
RESULTS
Six studies involving 2374 patients were included in the meta-analysis. The results of the meta-analysis showed that melatonin did not reduce the incidence of delirium in ICU patients (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.46 to 1.12; p = 0.14). There was a strong hetero-geneity between the selected studies (I = 74%). Subgroup analysis results showed that melatonin reduced the incidence of delirium in cardiovascular care unit (CCU) patients (OR: 0.52; 95% CI: 0.37 to 0.73; p=0.0001), but did not in general intensive care unit (GICU) patients (OR: 1.14; 95% CI: 0.86 to 1.50; p=0.35). In terms of the secondary outcomes, there were no significant differences in all-cause mortality (OR: 0.85; 95% CI: 0.66 to 1.09; p=0.20), length of ICU stay (mean difference [MD]: 0.33; 95% CI: -0.53 to 1.18; p=0.45), or length of hospital stay (MD: 0.51; 95% CI: -1.17 to 2.19; p=0.55).
CONCLUSION
Melatonin reduced the incidence of delirium in CCU patients, but did not significantly reduce the incidence of delirium in GICU patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022367665.
目的
评估褪黑素对 ICU 患者谵妄的预防作用。
方法
我们系统检索了 PubMed、Cochrane Library、Science、Embase 和中国知网（CNKI）数据库，检索时间从各数据库建库至 2022 年 9 月。纳入褪黑素与安慰剂对照用于预防 ICU 患者谵妄的对照试验。使用 Review Manager 软件（版本 5.3）和 Stata 软件（版本 14.0）进行荟萃分析。
结果
纳入的 6 项研究共 2374 例患者。荟萃分析结果显示，褪黑素不能降低 ICU 患者谵妄的发生率（比值比 [OR]：0.71；95%置信区间 [CI]：0.46 至 1.12；p=0.14）。纳入研究存在很强的异质性（I²=74%）。亚组分析结果显示，褪黑素可降低心血管重症监护病房（CCU）患者谵妄的发生率（OR：0.52；95% CI：0.37 至 0.73；p=0.0001），但不能降低综合重症监护病房（GICU）患者谵妄的发生率（OR：1.14；95% CI：0.86 至 1.50；p=0.35）。次要结局方面，褪黑素对全因死亡率（OR：0.85；95% CI：0.66 至 1.09；p=0.20）、ICU 住院时间（均数差 [MD]：0.33；95% CI：-0.53 至 1.18；p=0.45）或住院时间（MD：0.51；95% CI：-1.17 至 2.19；p=0.55）均无显著影响。
结论
褪黑素可降低 CCU 患者谵妄的发生率，但不能显著降低 GICU 患者谵妄的发生率。
系统评价注册
https://www.crd.york.ac.uk/prospero/，注册号 CRD42022367665。
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