[罂粟摘要]右美托咪定预防重症监护病房或恢复室成人患者的术后谵妄：随机临床试验的系统评价，Meta分析和试验序贯分析

右美托咪定预防重症监护病房或恢复室成人患者的术后谵妄：随机临床试验的系统评价，Meta分析和试验序贯分析

贵州医科大学 麻醉与心脏电生理课题组

翻译 :  马艳燕    

编辑 :  严旭   

审校 :  曹莹

目的：为了评估所有益处或危害，我们对在重症监护病房或恢复室中将成人分配到右美托咪定组或安慰剂组（无干预措施）以预防谵妄的随机临床试验进行了系统评价。

数据来源：我们检索了Medline，Embase，CENTRAL和其他数据库。最后一次检索是2022年4月9日。

数据提取：文献筛选、数据提取和第2卷偏倚风险评估是独立进行的，一式两份。主要结果是严重不良事件的发生、谵妄和全因死亡率。我们使用了meta分析、试验序贯分析和GRADE。

数据整理：81项随机临床试验（15745名患者）为我们的主要结果提供了数据。低偏倚风险试验的结果表明，右美托咪定可以减少最常见的严重不良事件的发生（相对风险（RR）0.69;95%CI 0.43-1.09）、累积严重不良事件（RR 0.70;95%CI 0.52-0.95）和谵妄的发生（RR 0.62;95%CI 0.43-0.89）。谵妄的证据质量极低。在低偏倚风险的试验中，死亡率非常低(右美托咪丁组为0.4%，对照组为1.0%)，meta分析未提供确凿证据表明右美托咪定可能导致更低或更高的全因死亡率（RR 0.47;95% CI 0.18-1.21）。所有主要结果均缺乏低偏倚风险的试验结果信息。

结论：低偏倚风险的试验结果表明，右美托咪定可能会减少严重不良事件和谵妄的发生，而没有发现确凿的证据证明对全因死亡率的影响。证据可信度从谵妄发生的极低到其余结局的低质量不等。

原始文献来源 ：Maagaard M, Barbateskovic M, Andersen-Ranberg NC, Kronborg JR, Chen YX, Xi HH, Perner A, Wetterslev J. Dexmedetomidine for the prevention of delirium in adults admitted to the intensive care unit or postoperative care unit: a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis. Acta Anaesthesiol Scand.

Dexmedetomidine for the prevention of delirium in adults admitted to the intensive care unit or postoperative care unit: a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis

Background: To assess any benefit or harm, we conducted a systematic review of randomised clinical trials allocating adults to dexmedetomidine versus placebo/no intervention for the prevention of delirium in intensive care units or postoperative care units.

Data sources：We searched Medline, Embase, CENTRAL, and other databases. The last search was 9 April 2022.

Data extraction：Literature screening, data extraction, and risk of bias volume 2 assessments were performed independently and in duplicate. Primary outcomes were occurrences of serious adverse events, delirium, and all-cause mortality. We used meta-analysis, Trial Sequential Analysis, and GRADE.

Data synthesis：Eighty-one randomised clinical trials (15,745 patients) provided data for our primary outcomes. Results from trials at low risk of bias showed that dexmedetomidine may reduce the occurrence of the most frequently reported serious adverse events (relative risk (RR) 0.69; 95% CI 0.43 to 1.09), cumulated serious adverse events (RR 0.70; 95% CI 0.52 to 0.95), and the occurrence of delirium (RR 0.62; 95% CI 0.43 to 0.89). The certainty of evidence was very low for delirium. Mortality was very low in trials at low risk of bias (0.4% in the dexmedetomidine groups and 1.0% in the control groups) and meta-analysis did not provide conclusive evidence that dexmedetomidine may result in lower or higher all-cause mortality (RR 0.47; 95% CI 0.18 to 1.21). There was a lack of information from trial results at low risk of bias for all primary outcomes.

Conclusions：Trial results at low risk of bias showed that dexmedetomidine might reduce occurrences of serious adverse events and delirium, while no conclusive evidence was found for effects on all-cause mortality. The certainty of evidence ranged from very low for occurrence of delirium to low for the remaining outcomes.

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