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

翻译：吴学艳  编辑：冯玉蓉  审校：曹莹

研究目的:据估计，80%接受手术的老年患者会发生术后谵妄(POD)，这使他们成为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后老年患者POD。

方法：数据库检索出336篇论文，仅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 0.74；95%CI 0.44，1.26)与安慰剂相比，在降低POD发病率方面没有统计学意义。

结论：需要实施多学科干预，以及临床医生在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;67DOI：10.1016/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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