抗精神病药预防老年术后谵妄的疗效与安全性系统评价

发布时间：2018-05-22 15:16

本文选题：谵妄 + 术后　；参考：《重庆医科大学学报》2017年10期

【摘要】：目的:评价抗精神病药预防老年术后谵妄的疗效及安全性。方法:计算机检索Cochrane图书馆临床对照试验数据库(2015年第10期)、Pub Med、Medline、Embase、相关期刊论文(CNKI)、维普数据库、万方数据库,检索时间均从建库至2015年10月。纳入所有抗精神病药预防老年术后谵妄的安慰剂随机对照研究。采用Rev Man 5.3软件进行Meta分析。结果:最终纳入6个随机对照研究,共1 355例患者。Meta分析结果显示:与安慰剂相比,预防性使用抗精神病药能降低老年术后谵妄的发生率,差异具有统计学意义(RR=0.47,95%CI=0.33~0.67,P=0.030);但在缩短住院时间(MD=-0.02,95%CI=-0.63~0.58,P=0.450)及减少死亡率上,两者无统计学差异。结论:现有证据表明,预防性使用抗精神病药能降低老年术后谵妄发生率,但不能缩短谵妄持续时间、住院时间及降低死亡率。受纳入研究数量和质量所限,上述结论可能存在偏倚,需开展更多高质量研究予以验证。
[Abstract]:Objective: to evaluate the efficacy and safety of antipsychotics in preventing postoperative delirium in elderly patients. Methods: the clinical controlled trial database of Cochrane Library was searched by computer (Pub Medline Embase in the 10th issue, 2015, CNKI, Weipu, Wanfang, Chinese Journal Full-text Database). The retrieval time was from the construction of the database to October 2015. A randomized controlled trial of all antipsychotics for the prevention of postoperative delirium in the elderly. Meta analysis was carried out with Rev Man 5.3 software. Results: a total of 1 355 patients were enrolled in 6 randomized controlled trials. Meta-analysis showed that prophylactic use of antipsychotics decreased the incidence of postoperative delirium in the elderly compared with placebo. The difference was statistically significant (P < 0.05), but there was no statistical difference between the two groups in terms of reducing the hospitalization time (MD-0.02 ~ 95CI-0.63 ~ 0.58P0.450) and the mortality rate (P = 0.030), but there was no significant difference between the two groups in reducing the mortality rate (P = 0.030), but there was no statistical difference between the two groups in terms of reducing the hospital stay and the mortality rate. Conclusion: available evidence suggests that prophylactic use of antipsychotics can reduce the incidence of postoperative delirium in the elderly, but it does not shorten the duration of delirium, hospital stay and mortality. Limited by the quantity and quality of the studies, these conclusions may be biased and need to be verified by more high-quality studies.
【作者单位】：四川大学华西医院老年医学中心;
【基金】：四川省科技厅科技国际合作项目(编号:2015HH0024) 厄玛保罗米尔斯坦老年健康专项和MMAAP基金会资助(编号:1403014)
【分类号】：R749

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