瑞马唑仑与谵妄及认知功能的关联：一项随机对照试验的系统评价和荟萃分析
Association of remimazolam with delirium and cognitive function: A systematic review and meta-analysis of randomised controlled trials.
作者信息
Arias Jaime Andres, Wegner Gustavo Roberto Minetto, Wegner Bruno Francisco Minetto, Silva Larissa Santos, Bezerra Francisco José Lucena, Filardi Rafaela Goes Machado
机构信息
From the Universidade Federal da Bahia, Hospital Ana Nery, Salvador, Brazil (JAA), Universidade Federal da Fronteira Sul, Passo Fundo (GRMW), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (BFMW), Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil (LSS), São Paulo (FJLB) and Universidade de São Paulo, São Paulo, Brazil (RGMF).
出版信息
Eur J Anaesthesiol. 2025 Apr 1;42(4):285-297. doi: 10.1097/EJA.0000000000002107. Epub 2024 Dec 18.
BACKGROUND AND STUDY OBJECTIVE
Delirium is an organic mental syndrome significantly associated with long-term cognitive decline, increased hospital stays and higher mortality. This systematic review of randomised controlled trials (RCTs) with meta-analysis assesses the association of remimazolam with postoperative cognitive function and delirium compared with non-benzodiazepine hypnotics.
DESIGN
Systematic review of RCTs with meta-analysis.
DATA SOURCES
PubMed, Embase, Cochrane Library and Web of Science databases up to 27 April 2024.
ELIGIBILITY CRITERIA
Adult patients undergoing general anaesthesia or sedation procedures; use of remimazolam as the primary hypnotic or as an adjunct, administered via intermittent bolus or continuous infusion; comparison with other hypnotics or sedatives; evaluation of cognitive function or delirium.
MAIN RESULTS
Twenty-three RCTs with 3598 patients were included. The incidence of delirium was not significantly different between remimazolam and other sedatives in general anaesthesia and sedation procedures [ n = 3261; odds ratio (OR) = 1.2, 95% confidence interval (CI), 0.76 to 1.91; P = 0.378843; I2 = 17%]. Regarding cognitive function evaluation, remimazolam showed no difference compared with the control group in Mini-Mental State Examination (MMSE) scores on the first postoperative day ( n = 263; mean difference = 0.60, 95% CI, -1.46 to 2.66; P = 0.5684; I2 = 90%) or on the third postoperative day ( n = 163; mean difference = 1.33, 95% CI, -0.72 to 3.38; P = 0.2028; I2 = 93%). Remimazolam exhibited superiority over the control group in MMSE scores on the seventh postoperative day ( n = 247; mean difference = 0.53, 95% CI, 0.30 to 0.75; P < 0.0001; I2 = 28%).
CONCLUSION
Remimazolam does not increase the incidence of delirium or cognitive impairments compared with non-benzodiazepine hypnotics. However, the analysis showed that the type of surgery significantly influenced the incidence of delirium. Additionally, remimazolam was associated with better short-term postoperative cognitive function.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42024532751.
背景与研究目的
谵妄是一种器质性精神综合征，与长期认知功能下降、住院时间延长和死亡率升高显著相关。本项对随机对照试验（RCT）进行的系统评价及荟萃分析，评估了瑞马唑仑与非苯二氮䓬类催眠药相比，与术后认知功能和谵妄的相关性。
设计
对RCT进行系统评价及荟萃分析。
数据来源
截至2024年4月27日的PubMed、Embase、Cochrane图书馆和科学网数据库。
纳入标准
接受全身麻醉或镇静程序的成年患者；使用瑞马唑仑作为主要催眠药或辅助药物，通过间歇性推注或持续输注给药；与其他催眠药或镇静剂进行比较；评估认知功能或谵妄。
主要结果
纳入了23项RCT，共3598例患者。在全身麻醉和镇静程序中，瑞马唑仑与其他镇静剂相比，谵妄发生率无显著差异[n = 3261；优势比（OR）= 1.2，95%置信区间（CI）为0.76至1.91；P = 0.378843；I² = 17%]。关于认知功能评估，在术后第一天，瑞马唑仑与对照组相比，简易精神状态检查表（MMSE）评分无差异（n = 263；平均差异 = 0.60，95% CI为 -1.46至2.66；P = 0.5684；I² = 90%），在术后第三天也无差异（n = 163；平均差异 = 1.33，95% CI为 -0.72至3.38；P = 0.2028；I² = 93%）。在术后第七天，瑞马唑仑的MMSE评分优于对照组（n = 247；平均差异 = 0.53，95% CI为0.30至0.75；P < 0.0001；I² = 28%）。
结论
与非苯二氮䓬类催眠药相比，瑞马唑仑不会增加谵妄或认知障碍的发生率。然而，分析表明手术类型对谵妄发生率有显著影响。此外，瑞马唑仑与术后较好短期认知功能相关。
系统评价注册
PROSPERO CRD42024532751
Zotero 插件