【罂粟摘要】围术期麻醉药预防全麻术后谵妄的效果：网络meta分析
围术期麻醉药预防全麻术后谵妄的效果：网络meta分析
术后谵妄（POD）是外科手术患者常见的神经系统疾病。在临床实践中，麻醉医师有广泛的镇静剂选择，涉及不同的机制，并且POD的发生率因使用镇静剂不同而不同。本网络meta分析旨在综合评估每种药物选择对患者的安全性和有效性。
网络meta分析。
范德比尔特大学医学中心。
截至2018年9月底，我们检索了PubMed、EMBASE、Ovid Medline和Cochrane 对照试验注册中心（CENTRAL）相关数据，注册号为CRD42018110585。随机对照试验由两名独立的评审员鉴定和提取。本网络meta分析评估了常用的镇静药，如安慰剂、七氟烷、地氟烷、异氟烷、右美托咪定、丙泊酚、咪达唑仑和氯胺酮。主要结果是POD的发生率。数据通过网络meta分析合成。采用随机效应模型进行配对meta分析。根据累积排序曲线（SUCRA）下的相应曲面对每一干预措施进行排序。采用GRADE 框架来评估偏倚风险。
我们在这项meta分析中确定了39个随机对照试验和5991例患者。与咪达唑仑、异丙酚、地氟醚和七氟醚相比，右美托咪定是减少POD的最有效的选择。结果显示右美托咪定与较低的POD发生率相关，而咪达唑仑与谵妄患者数量显著增加相关。咪唑安定和异丙酚也与围术期低血压和心动过缓的高发生率相关。
本研究提供了meta分析证据，提示右美托咪定可能是降低POD的最有效的镇静剂。然而，临床医生在为个别病人选择镇静剂之前仍然需要权衡利弊。
Cui Yu, Li Gen, Cao Rong, et al. The effect of perioperative anesthetics for prevention of postoperative delirium on general anesthesia: A network meta-analysis.[J].Journal of Clinical Anesthesia,59:89-98.
The effect of perioperative anesthetics for prevention of postoperative delirium on general anesthesia: A network meta-analysis
ABSTRACT
Study objective: Postoperative delirium (POD) is a common neurological system disorder in surgical patients. Anesthesia providers have a wide choice of sedative agents involving different mechanisms in clinical practice, and the incidence of POD varies regarding which sedative agent administered. This network meta-analysis aimed to comprehensively analyze the safety and efficacy of each choice for patients.
Design: A network meta-analysis.
Setting: Vanderbilt University Medical Center.
Measurements: We searched PubMed, EMBASE, Ovid Medline and Cochrane Central Register of Controlled Trials (CENTRAL) through the end of September 2018 with the registration number CRD42018110585. The randomized controlled trials were identified and extracted by two reviewers independently. Commonly used sedative agents such as placebo, sevoflurane, desflurane, isoflurane, dexmedetomidine, propofol, midazolam, and ketamine were assessed in this network meta-analysis and the primary outcome was the incidence of POD. The data were synthesized by network meta-analysis. Pair-wise meta-analyses were conducted using the random-effects model. Each intervention was ranked according to its corresponding surface under the cumulative ranking curve (SUCRA) values. The GRADE framework was undertaken to evaluate the risk of bias.
Main results: We identified 39 RCTs and 5991 patients in this meta-analysis. Dexmedetomidine was found to be the most effective option in reducing POD, compared to midazolam, propofol, desflurane, and sevoflurane. The results revealed that dexmedetomidine was associated with a lower incidence of POD, whereas midazolam was associated with a significantly higher number of patients with delirium. Midazolam and propofol were also associated with a higher incidence of perioperative hypotension and bradycardia.
Conclusion: Our study provided meta-analytic evidence and suggested dexmedetomidine could be considered as the most effective sedative agent to reduce POD. However, clinical practitioners still need to weigh the pros and cons before choosing a sedative agent for individual patient.
翻译：冯玉蓉 编辑：佟睿 审校：曹莹