新斯的明对术后神经认知功能障碍的影响：一项系统评价和荟萃分析。

Effects of neostigmine on postoperative neurocognitive dysfunction: a systematic review and meta-analysis.

作者信息

Zhou Xuelei, Chen Linlin, Zhao Li, Mao Wei, Liu Xianchun, Zhang Longyi, Xie Ying, Li Linji

机构信息

Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, China.

出版信息

Front Neurosci. 2025 Mar 7;19:1464272. doi: 10.3389/fnins.2025.1464272. eCollection 2025.

DOI:10.3389/fnins.2025.1464272

PMID:40125478

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11925933/

Abstract

INTRODUCTION

Postoperative neurocognitive dysfunction (PND) is a common and serious complication following surgery. Neostigmine, an acetylcholinesterase inhibitor commonly administered during anesthesia to reverse residual neuromuscular blockade, has been suggested in recent studies to potentially reduce the incidence of PND. However, findings have been inconsistent across studies. Therefore, this study conducts a systematic review and meta-analysis to evaluate the effect of neostigmine on PND.

METHODS

We conducted a comprehensive literature search across multiple databases, including PubMed, EmBase, Web of Science, Cochrane Library, Scopus, SinoMed, and CNKI, to identify all relevant studies for inclusion. We included randomized controlled trials and cohort studies in our analysis. The risk of bias was assessed using the Risk of Bias 2 tool for randomized trials and the ROBINS-I tool for cohort studies.

RESULTS

A total of 11 studies were included in this analysis, consisting of 8 randomized controlled trials and 3 cohort studies. The incidence of PND was significantly lower in the neostigmine group compared to the control group (log(OR): -0.54, 95% CI [-1.04, -0. 05]; OR: 0.58, 95% CI: [0.35, 0.95],  = 0.03, I = 81.95%). Sensitivity analysis led to the exclusion of one cohort study. Consequently, the final meta-analysis comprised 10 studies, encompassing a total of 50,881 participants. The results indicate that the incidence of PND was significantly lower in the neostigmine group compared to the control group (log(OR):-0. 27, 95% CI [-0.47, -0. 08]; OR: 0.76, 95% CI: [0.62, 0.91],  = 0.01, I = 2.50%). However, Meta-analysis of RCTs and cohort studies showed no significant difference. Subgroup analysis indicated that neostigmine reduced the incidence of delayed neurocognitive recovery (dNCR), but its impact on POD was unclear, with no significant association to nausea and vomiting. These findings suggest that neostigmine may reduce the risk of PND, but caution is needed in interpretation.

CONCLUSION

Neostigmine may have a potential positive effect in reducing the incidence of PND. However, no statistical difference was observed when meta-analyses were performed separately for randomized controlled trials (RCTs) and cohort studies. Given the limited number of studies available and the limitations of the current research, further investigation is needed to clarify the impact of neostigmine on PND.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024537647, Identifier CRD42024537647.

摘要

引言

术后神经认知功能障碍（PND）是手术后常见且严重的并发症。新斯的明是一种在麻醉期间常用的乙酰胆碱酯酶抑制剂，用于逆转残余的神经肌肉阻滞，最近的研究表明它可能降低PND的发生率。然而，各研究结果并不一致。因此，本研究进行了系统评价和荟萃分析，以评估新斯的明对PND的影响。

方法

我们在多个数据库中进行了全面的文献检索，包括PubMed、EmBase、Web of Science、Cochrane图书馆、Scopus、中国生物医学文献数据库和中国知网，以确定所有纳入的相关研究。我们的分析纳入了随机对照试验和队列研究。使用随机试验的偏倚风险2工具和队列研究的ROBINS-I工具评估偏倚风险。

结果

本分析共纳入11项研究，包括8项随机对照试验和3项队列研究。与对照组相比，新斯的明组PND的发生率显著降低（对数比值比：-0.54，95%置信区间[-1.04，-0.05]；比值比：0.58，95%置信区间：[0.35，0.95]，P = 0.03，I² = 81.95%）。敏感性分析导致排除一项队列研究。因此，最终的荟萃分析包括10项研究，共50881名参与者。结果表明，与对照组相比，新斯的明组PND的发生率显著降低（对数比值比：-0.27，95%置信区间[-0.47，-0.08]；比值比：0.76，95%置信区间：[0.62，0.91]，P = 0.01，I² = 2.50%）。然而，随机对照试验和队列研究的荟萃分析显示无显著差异。亚组分析表明，新斯的明降低了延迟神经认知恢复（dNCR）的发生率，但其对术后谵妄（POD）的影响尚不清楚，与恶心和呕吐无显著关联。这些发现表明新斯的明可能降低PND的风险，但在解释时需要谨慎。