[罂粟摘要]右美托咪定预防重症监护病房或术后护理病房成人患者的谵妄：随机临床试验的系统综述，meta分析和试验序贯分析

右美托咪定预防重症监护病房或术后护理病房成人患者的谵妄：随机临床试验的系统综述，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：为了评估任何益处或危害，我们对随机临床试验（RCTs）进行了系统综述，这些试验将成人分配到右美托咪定组与安慰剂/无干预组，以预防在重症监护病房或术后护理病房中的谵妄。

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、资料提取和2型偏倚风险评估是独立进行的，一式两份。主要结局是严重不良事件（SAEs）、谵妄和全因死亡率的发生。我们使用了meta分析、试验序贯分析和GRADE（建议分级评估、制定和评价)评分。

数据分析：主要结局的数据来自于81项随机对照试验（15745名患者）。低偏倚风险试验的结果表明，右美托咪定可以减少最常的SAEs（相对风险[RR] 0.69;95%CI 0.43–1.09）、累积SAEs（RR 0.70;95%CI 0.52–0.95）和谵妄（RR 0.62;95%CI 0.43–0.89）的发生。谵妄的证据质量极低。低偏倚风险试验的死亡率非常低（右美托咪定组为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全因死亡率降低或升高（RR 0.47;95% CI 0.18–1.21）。所有主要结局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SAEs和谵妄的发生，而没有发现确凿的证据证明其对全因死亡率的影响。证据质量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 post-operative care unit: A systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis. Acta Anaesthesiol Scand. 2023 Apr;67(4):382-411. doi: 10.1111/aas.14208. 

英文原文

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

Objectives：To assess any benefit or harm, we conducted a systematic review of randomised clinical trials (RCTs) allocating adults to dexmedetomidine versus placebo/no intervention for the prevention of delirium in intensive care or post-operative 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 (SAEs), delirium and all-cause mortality. We used meta-analysis, Trial Sequential Analysis, and GRADE (Grading Recommendations Assessment, Development and Evaluation).

Data Synthesis：Eighty-one RCTs (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 SAEs (relative risk [RR] 0.69; 95% CI 0.43–1.09), cumulated SAEs (RR 0.70; 95% CI 0.52–0.95) and the occurrence of delirium (RR 0.62; 95% CI 0.43–0.89). 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 0.18–1.21). 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 SAEs 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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