多学科和药物干预减少老年患者术后谵妄:系统回顾和Meta分析

2020
09/02

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研究在世界各地进行。


多学科和药物干预减少老年患者术后谵妄:系统回顾Meta分析

翻译:吴学艳  编辑:冯玉蓉  审校:曹莹


研究目的:估计,80%接受手术的老年患者发生术后谵妄(POD)使他们成为POD高危人群减少老年患者发生POD这一领域的研究正在迅速发展,但对POD预防或管理的策略尚未形成共识我们进行了一项系统回顾和Meta分析以综合临床干预数据,致力于减少择期和急诊手术老年患者POD


方法数据库检索336篇论文,25项研究符合纳入标准,并使用Joanna Briggs研究所文献评估检查表进行评估,这些研究在世界各地进行。


结果:本综述评估了一系列干预方法比较了麻醉剂和镇静剂、药物特异性干预和多学科护理模式。结果发现与药物干预相比,多学科干预的结果更加一致。在汇总分析中,氟哌啶醇(OR 0.7495%CI 0.441.26)与安慰剂相比在降低POD发病率方面没有统计学意义


结论:要实施多学科干预以及临床医生术前和术后的药物干预护理实践方面相互协作,可更有效地减少和管理老年患者POD


原始文献来源:   Igwe EO,  Nealon J,  Mohammed M, et al. Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis.[J].J Clin Anesth 2020 Aug 05;67DOI10.1016/j.jclinane.2020.110004.



Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis


ABSTRACT

Study objective: An estimated 80% of older people undergoing surgery develop postoperative delirium (POD) making them a high-risk group. Research in this area is growing fast but there is no established consensus on strategies for POD prevention or management. A systematic review and meta-analysis were conducted to synthesise data on clinical interventions used to reduce POD among older people undergoing   elective and emergency surgery.


Methods: A range of database searches generated 336 papers. A total of 25 studies met the inclusion criteria and were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The studies were undertaken across the world.


Results: This review identifified a range of intervention approaches: comparisons between anaesthetic and sedatives agents, medication-specifific interventions and multidisciplinary models of care. Results found more consistencies across multidisciplinary interventions than the pharmacological interventions. In pooled analyses, haloperidol (OR 0.74; 95% CI (confifidence interval) 0.44, 1.26) was not statistically signifificantly associated with reduced POD incidence any more than a placebo.


Conclusion: There is a need to implement multidisciplinary interventions, as well as collaboration between clinicians on pre- and postoperative care practices regarding pharmacological interventions to more effffectively reduce and manage POD in older people.

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关键词:
POD,interventions,干预

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