【罂粟摘要】术前炎症介质和术后谵妄：系统回顾和meta分析

术前炎症介质和术后谵妄：系统回顾和meta分析

贵州医科大学     麻醉与心脏电生理课题组

翻译：胡廷菊  编辑：马艳燕   审核：曹莹

罂 粟 摘 要 

背景：术后谵妄一直未能确定其复杂病因和描述其具体的危险因素。已有研究通过检测术前血液中“固有”炎性介质水平来评估神经炎症作为危险因素的作用。然而，结果存在争议。我们对老年人术前血液中炎症介质水平与术后谵妄之间的相关性证据进行了系统回顾和meta分析。同时也评估了手术类型的影响。

方法：纳入17篇在同行评审期刊上发表的、符合资格标准的原创、低偏倚风险的文章。在系统回顾和meta分析的首选报告项目(PRISMA)和预后研究的质量指南的指导下进行数据提取、合成和偏倚风险分析。meta分析采用了随机效应模型。炎症介质包括C反应蛋白、白细胞介素-6、白细胞介素-8和白细胞介素-10、肿瘤坏死因子-α、胰岛素样生长因子-1、皮质醇和新蝶呤。手术类型包括心脏、非心脏手术和髋部骨折手术。

结果：术前较高的白细胞介素-6与术后谵妄相关，标准化平均差异为0.33(0.11-0.56；95%CI；P=0.003）。较高的新蝶呤水平也与术后谵妄有关。

结论：术前血液中炎症介质水平与术后谵妄的关系可能受手术类型和特定介质的影响。需要在未来的研究中考虑手术类型的潜在调节作用、脑的内在脆弱性以及炎症介质和结合蛋白之间复杂的相互作用。

原始文献来源：Noah AM, Almghairbi D, Evley R, Moppett IK. Preoperative inflammatory mediators and postoperative delirium: systematic review and meta-analysis. Br J Anaesth. 2021 Sep;127(3):424-434.

英文原文

Preoperative inflammatory mediators and postoperative delirium: systematic review and meta-analysis

Background: Postoperative delirium has eluded attempts to define its complex aetiology and describe specific risk factors. The role of neuroinflammation as a risk factor, determined by measuring blood levels of preoperative ‘innate’ inflammatory mediator levels, has been investigated. However, results have been conflicting. We conducted a systematic review and meta-analysis of the evidence on associations between preoperative blood levels of inflammatory mediators and postoperative delirium in the older person. Influence of type of surgery was also assessed.  

Methods: Original, low risk of bias studies, published in peer-reviewed journals, which fulfilled the eligibility criteria were included. Seventeen articles fulfilled study criteria. Data extraction, synthesis, and risk of bias analysis were guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and quality in prognostic studies guidelines. Meta-analyses used a random-effects model. Inflammatory mediators included C-reactive protein, interleukin-6, -8, and -10, tumour necrosis factor-α, insulin-like growth factor-1, cortisol, and neopterin. Surgical groups were cardiac, noncardiac, and hip fracture.

Results: Higher preoperative interleukin-6 was associated with postoperative delirium with a standardised mean difference (95% confidence interval) of 0.33 (0.11-0.56) and P=0.003. Higher neopterin was also associated with postoperative delirium. 

Conclusions: The association of preoperative blood levels of inflammatory mediators with postoperative delirium may be influenced by the type of surgery and the specific mediator. The potential modulating effect of type of surgery, intrinsic brain vulnerability, and the complex interactions between inflammatory mediators and binding proteins will need to be considered in future studies.

打赏