中国循证医学杂志

中国循证医学杂志

右美托咪定对老年患者术后早期认知功能障碍及炎症因子影响的 Meta 分析

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目的系统评价右美托咪定对老年患者术后早期认知功能障碍(POCD)及炎症因子的影响。方法计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI、WanFang Data 和 VIP 数据库,搜集关于右美托咪定对老年患者 POCD 影响的随机对照试验(RCT),检索时限均为建库至 2017 年 4 月。由 2 位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果纳入 23 个 RCT,共 2 026 例患者。Meta 分析结果显示,右美托咪定组的老年患者 POCD 发生率[第 1 天:RR=0.40,95%CI(0.30,0.53),P<0.000 01;第 3 天:RR=0.33,95%CI(0.23,0.48),P<0.000 01;第 7 天:RR=0.42,95%CI(0.22,0.78),P=0.006]明显低于对照组。同时,与对照组相比,右美托咪定能显著降低患者术后血清 TNF-α 水平[手术结束时:MD=–5.43,95%CI(–7.44,–3.42),P<0.000 01;术后 1 小时:MD=–4.64,95%CI(–6.92,–2.36),P<0.000 1;术后 24 小时:MD=–3.27,95%CI(–4.92,–1.63),P<0.000 1]和血清 IL-6 水平[手术结束时:MD=–30.69,95%CI(–41.39,–20.00),P<0.000 01;术后 1 小时:MD=–20.84,95%CI(–28.87,–12.80),P<0.000 01;术后 24 小时:MD=–13.42,95%CI(–19.90,–6.94),P<0.000 1]。结论围术期应用右美托咪定能缓解老年患者早期 POCD。其中,降低血清炎症因子来拮抗术后炎症反应可能起到重要作用。受纳入研究数量和质量所限,上述结论尚需高质量多中心 RCT 研究予以验证。

ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and serum inflammatory factors in elderly patients.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases from inception to April 2017, to collect randomized controlled trials (RCTs) about dexmedetomidine for early POCD in elderly patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 RCTs, including 2 026 patients were enrolled. The results of meta-analysis showed that, the incidence of POCD in the dexmedetomidine group was lower than that in the control group (the first day: RR=0.40, 95%CI 0.30 to 0.53, P<0.000 01; the third day: RR=0.33, 95%CI 0.23 to 0.48,P<0.000 01; the seventh day: RR=0.42, 95%CI 0.22 to 0.78,P=0.006). Meanwhile, compared with the control group, the dexmedetomidine group significantly decreased the serum levels of TNF-α (immediately after operation: MD=–5.43, 95%CI –7.44 to –3.42, P<0.000 01; 1 h after operation: MD=–4.64, 95%CI –6.92 to –2.36,P<0.000 1; 24 h after operation: MD=–3.27, 95%CI –4.92 to –1.63,P<0.000 1) and IL-6 (immediately after operation: MD=–30.69, 95%CI –41.39 to –20.00,P<0.000 01; 1h after operation: MD=–20.84, 95%CI –28.87 to –12.80,P<0.000 01; 24 h after operation: MD=–13.42, 95%CI –19.90 to –6.94,P<0.000 1).ConclusionCurrent evidence indicates that dexmedetomidine could relief early POCD in elderly patients, in which the reduction of serum inflammatory factors alleviate inflammation response may play a vital role. Due to the limited quality and quantity of included studies, more high quality RCTs are required to verify the above conclusion.

关键词: 右美托咪定; 炎症因子; 老年患者; 术后认知功能障碍; Meta 分析; 系统评价; 随机对照试验

Key words: Dexmedetomidine; Inflammatory factors; Elderly patients; Postoperative cognitive dysfunction; Meta-analysis; Systematic review; Randomized controlled trial

引用本文: 唐娅星, 何丽丽, 刘玲, 唐晓宁. 右美托咪定对老年患者术后早期认知功能障碍及炎症因子影响的 Meta 分析. 中国循证医学杂志, 2018, 18(3): 351-362. doi: 10.7507/1672-2531.201707090 复制

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