术前认知训练可改善术后认知功能：一项随机对照试验的荟萃分析和系统评价
Preoperative cognitive training improves postoperative cognitive function: a meta-analysis and systematic review of randomized controlled trials.
作者信息
Zhao Li, Guo Yiping, Zhou Xuelei, Mao Wei, Li Linji
机构信息
Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China.
School of Humanities and Management, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, China.
出版信息
Front Neurol. 2024 Jan 8;14:1293153. doi: 10.3389/fneur.2023.1293153. eCollection 2023.
BACKGROUND
Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are common post-surgical complications that often lead to prolonged hospitalization, reduced quality of life, increased healthcare costs, and increased patient mortality. We conducted a meta-analysis to evaluate the effects of preoperative cognitive function training on postoperative cognitive function.
METHODS
PubMed, Cochrane Library, Embase, Web of Science, ClinicalTrials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and Chinese Biomedical Literature Database were searched for randomized controlled trials comparing the effects of preoperative cognitive function training and conventional preoperative measures on postoperative cognitive function. The search period spanned from the establishment of the databases to March 31, 2023. The primary outcomes were the incidence of POCD and POD.
RESULTS
Eleven randomized controlled trials involving 1,045 patients were included. The results of the meta-analysis showed that, compared to the control group, preoperative cognitive function training significantly reduced the incidence of POCD (RR = 0.38, < 0.00001), and there was no statistically significant difference in the incidence of POD ( = 0.3). Cognitive function training significantly improved postoperative cognitive function scores compared with the control group (MD = 1.92, = 0.001). In addition, two studies reported that 10% of the patients in the cognitive training group completed a pre-set training duration.
CONCLUSION
Cognitive function training significantly reduced the incidence of POCD; however, there was no significant difference in the incidence of POD. Preoperative cognitive function training should be promoted and emphasized as a simple, economical, and practical method of improving postoperative cognitive function.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=396154.
背景
术后认知功能障碍（POCD）和术后谵妄（POD）是常见的术后并发症，常导致住院时间延长、生活质量下降、医疗费用增加及患者死亡率上升。我们进行了一项荟萃分析，以评估术前认知功能训练对术后认知功能的影响。
方法
检索了PubMed、Cochrane图书馆、Embase、科学网、临床试验、中国知网、万方数据库、维普数据库和中国生物医学文献数据库，查找比较术前认知功能训练与传统术前措施对术后认知功能影响的随机对照试验。检索期从各数据库建立至2023年3月31日。主要结局指标为POCD和POD的发生率。
结果
纳入11项涉及1045例患者的随机对照试验。荟萃分析结果显示，与对照组相比，术前认知功能训练显著降低了POCD的发生率（RR = 0.38，< 0.00001），POD的发生率无统计学显著差异（ = 0.3）。与对照组相比，认知功能训练显著提高了术后认知功能评分（MD = 1.92， = 0.001）。此外，两项研究报告称认知训练组中有10%的患者完成了预设的训练时长。
结论
认知功能训练显著降低了POCD的发生率；然而，POD的发生率无显著差异。术前认知功能训练作为一种改善术后认知功能的简单、经济且实用的方法，应予以推广和重视。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=396154 。
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