Cole M G, Primeau F, McCusker J
St. Mary's Hospital, Montreal QC.
CMAJ. 1996 Nov 1;155(9):1263-8.
To determine the effectiveness of interventions to prevent delirium in hospitalized patients.
Two databases, MEDLINE and CINAHL, were searched for relevant articles published from January 1966 to May 1995 and from January 1982 to May 1995 respectively. The bibliographies of identified articles were searched for additional references.
Ten articles met the following three inclusion criteria: (a) original research article, (b) published in English or French and (c) controlled trial (nonrandomized or randomized) of an intervention to prevent delirium in hospitalized patients. The validity of the studies was independently assessed according to the criteria for intervention studies proposed by the Evidence-Based medicine Working Group.
Information about study design, patient population, sample size, diagnostic criteria, interventions and results was systematically abstracted from each report. Absolute risk reduction (ARR) for delirium was calculated for each study.
Eight trials involved surgical patients and two involved elderly medical patients; most of the studies had serious methodological limitations. Among the surgical patients the ARRs ranged from -13% to 81% and were not related to the type or timing of the intervention, or to the personnel involved. Among the elderly medical patients the ARRs ranged from -3% to 3%.
Interventions to prevent delirium among surgical patients may be modestly effective, but further trials are necessary.
确定预防住院患者谵妄的干预措施的有效性。
分别检索了两个数据库MEDLINE和CINAHL，以查找1966年1月至1995年5月以及1982年1月至1995年5月发表的相关文章。对已识别文章的参考文献进行检索以获取更多参考文献。
十篇文章符合以下三项纳入标准：（a）原创研究文章，（b）以英文或法文发表，（c）预防住院患者谵妄的干预措施的对照试验（非随机或随机）。根据循证医学工作组提出的干预研究标准对研究的有效性进行独立评估。
从每份报告中系统提取有关研究设计、患者人群、样本量、诊断标准、干预措施和结果的信息。计算每项研究中谵妄的绝对风险降低率（ARR）。
八项试验涉及外科患者，两项涉及老年内科患者；大多数研究存在严重的方法学局限性。在外科患者中，ARR范围为-13%至81%，且与干预措施的类型或时间以及相关人员无关。在老年内科患者中，ARR范围为-3%至3%。
预防外科患者谵妄的干预措施可能有一定效果，但需要进一步试验。
