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翻譯：吳學(xué)艷  編輯：馮玉蓉  審校：曹瑩

研究目的:據(jù)估計(jì)，80%接受手術(shù)的老年患者會(huì)發(fā)生術(shù)后譫妄(POD)，這使他們成為POD高危人群。減少老年患者發(fā)生POD這一領(lǐng)域的研究正在迅速發(fā)展，但對(duì)POD預(yù)防或管理的策略尚未形成共識(shí)。我們進(jìn)行了一項(xiàng)系統(tǒng)回顧和Meta分析以綜合臨床干預(yù)數(shù)據(jù)，致力于減少擇期和急診手術(shù)后老年患者POD。

方法：數(shù)據(jù)庫檢索出336篇論文，僅25項(xiàng)研究符合納入標(biāo)準(zhǔn)，并使用Joanna Briggs研究所文獻(xiàn)評(píng)估檢查表進(jìn)行評(píng)估，這些研究在世界各地進(jìn)行。

結(jié)果：本綜述評(píng)估了一系列干預(yù)方法，比較了麻醉劑和鎮(zhèn)靜劑、藥物特異性干預(yù)和多學(xué)科護(hù)理模式。結(jié)果發(fā)現(xiàn)與藥物干預(yù)相比，多學(xué)科干預(yù)的結(jié)果更加一致。在匯總分析中，氟哌啶醇(OR 0.74；95%CI 0.44，1.26)與安慰劑相比，在降低POD發(fā)病率方面沒有統(tǒng)計(jì)學(xué)意義。

結(jié)論：需要實(shí)施多學(xué)科干預(yù)，以及臨床醫(yī)生在術(shù)前和術(shù)后的藥物干預(yù)護(hù)理實(shí)踐方面相互協(xié)作，可更有效地減少和管理老年患者POD。

原始文獻(xiàn)來源:   Igwe EO,  Nealon J,  Mohammed M, et al. Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis.[J].J Clin Anesth 2020 Aug 05;67DOI：10.1016/j.jclinane.2020.110004.

Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis

ABSTRACT

Study objective: An estimated 80% of older people undergoing surgery develop postoperative delirium (POD) making them a high-risk group. Research in this area is growing fast but there is no established consensus on strategies for POD prevention or management. A systematic review and meta-analysis were conducted to synthesise data on clinical interventions used to reduce POD among older people undergoing   elective and emergency surgery.

Methods: A range of database searches generated 336 papers. A total of 25 studies met the inclusion criteria and were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The studies were undertaken across the world.

Results: This review identifified a range of intervention approaches: comparisons between anaesthetic and sedatives agents, medication-specifific interventions and multidisciplinary models of care. Results found more consistencies across multidisciplinary interventions than the pharmacological interventions. In pooled analyses, haloperidol (OR 0.74; 95% CI (confifidence interval) 0.44, 1.26) was not statistically signifificantly associated with reduced POD incidence any more than a placebo.

Conclusion: There is a need to implement multidisciplinary interventions, as well as collaboration between clinicians on pre- and postoperative care practices regarding pharmacological interventions to more effffectively reduce and manage POD in older people.