Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (2): 121-134.doi: 10.24920/003630

• 论著 • 上一篇    下一篇

盐酸戊乙奎醚作为术前用药不增加术后认知功能障碍及术后谵妄发生率:一项系统综述和meta分析

姚允泰1,a*(),应华2,方能新1a,张永保1b,袁昕1c   

  1. 1a. 麻醉科; 阜外医院,国家心血管病中心,中国医学科学院 & 北京协和医学院,北京 100037,中国
    1b. 血管外科;阜外医院,国家心血管病中心,中国医学科学院 & 北京协和医学院,北京 100037,中国
    1c. 成人心外科;阜外医院,国家心血管病中心,中国医学科学院 & 北京协和医学院,北京 100037,中国
    2. 上海市骨科内植物重点实验室,上海交通大学医学院附属第九人民医院骨科,上海 200011,中国
  • 收稿日期:2019-06-15 接受日期:2019-08-20 出版日期:2020-06-30 发布日期:2020-06-08
  • 通讯作者: 姚允泰 E-mail:yuntaiyao@126.com

Penehyclidine Hydrochloride Premedication Is Not Associated with Increased Incidence of Post-Operative Cognitive Dysfunction or Delirium:A Systemic Review and Meta-Analysis

Yao Yuntai1,a*(),Ying Hua2,Fang Nengxin1a,Zhang Yongbao1b,Yuan Xin1c   

  1. 1a. Department of Anesthesiology; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
    1b. Department of Vascular Surgery; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
    1c. Department of Adult Cardiac Surgery; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
    2. Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
  • Received:2019-06-15 Accepted:2019-08-20 Published:2020-06-30 Online:2020-06-08
  • Contact: Yao Yuntai E-mail:yuntaiyao@126.com

摘要: 目的 术后认知功能障碍(POCD)和术后谵妄(POD)是常见的术后脑部并发症。本研究旨在系统综述盐酸戊乙奎醚(PHC)对POCD和POD的影响。方法 通过电子数据库检索所有比较PHC和阿托品/东莨菪碱/安慰剂对POCD和PD发生的临床随机对照研究。由两位研究者分别提取文献中围术期资料,包括患者基线特征、手术情况和结局信息。主要结局指标包括术后POCD和POD的发生率,次要结局指标包括围术期简易精神状态评估(MMSE)得分。采用比值比(OR)和95%置信区间(CI)评估POCD及POD发生率。根据结局指标是否存在异质性,分别采用随机效应模型或固定效应模型分析;采用加权均数差(WMD)和95%CI评估MMSE得分。P<0.05时认为存在统计学显著差异。结果 检索得到33项研究共计4017位患者。Meta分析显示,PHC组患者POCD发生率与生理盐水组(OR=0.97;95% CI:0.58-1.64;P=0.92)、东莨菪碱组(OR=0.78;95% CI:0.48-1.27;P=0.32)及阿托品组(OR=1.20;95% CI:0.86-1.67;P=0.29)均相当。PHC组患者POD发生率与生理盐水组(OR=1.53;95% CI:0.81-2.90:P=0.19)、东莨菪碱组(OR=0.53;95% CI:0.06-4.56;P=0.56)无差别,但高于阿托品组(OR=4.49;95% CI:1.34-15.01;P=0.01)。结果 与东莨菪碱或安慰剂对比,盐酸戊乙奎醚作为术前用药并不增加POCD和POD的发生率。

关键词: 盐酸戊乙奎醚, 术后认知功能障碍, 术后谵妄, meta分析

Abstract: Objective Post-operative cognitive dysfunction (POCD) and post-operative delirium (POD) are two common post-operative cerebral complications. The current meta-analysis was to systematically review the effects of penehyclidine hydrochloride (PHC) on POCD and POD in surgical patients.Methods Electronic databases were searched to identify all randomized controlled trials comparing PHC with atropine/scopolamine/placebo on POCD and POD in surgical patients. Primary outcomes of interest included the incidences of POCD and POD; the secondary outcomes of interest included peri-operative mini-mental state examination (MMSE) scores. Two authors independently extracted peri-operative data, including patients’ baseline characteristics, surgical variables, and outcome data. For dichotomous data (POCD and POD occurrence), treatment effects were calculated as odds ratio (OR) and 95% confidential interval (CI). Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity. For continuous variables (MMSE scores), treatment effects were calculated as weighted mean difference (WMD) and 95% CI. Statistical significance was defined as P<0.05.Results Our search yielded 33 studies including 4017 patients. Meta-analysis showed that, the incidence of POCD in PHC group was comparable to that in saline group (OR=0.97; 95% CI: 0.58-1.64; P=0.92), scopolamine group (OR=0.78; 95% CI: 0.48-1.27; P=0.32) and atropine group (OR=1.20; 95% CI: 0.86-1.67; P=0.29). The incidence of POD in PHC group was comparable to that in saline group (OR=1.53; 95% CI: 0.81-2.90; P=0.19) and scopolamine group (OR=0.53; 95% CI: 0.06-4.56; P=0.56), but higher than that in atropine group (OR=4.49; 95% CI: 1.34-15.01; P=0.01).Conclusions PHC premedication was not associated with increased incidences of POCD or POD as compared to either scopolamine or placebo.

Key words: penehyclidine hydrochloride, post-operative cognitive dysfunction, post-operative delirium, meta-analysis

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