口腔颌面部手术术后谵妄危险因素的Meta分析  

Risk factors for postoperative delirium after oral and maxillofacial surgery:a Meta-analysis

作　　者：余晓宁 蔡洁琛[2] 黄利浩 竺越 侯劲松[1] Yu Xiaoning;Cai Jiechen;Huang Lihao;Zhu Yue;Hou Jinsong(Guanghua School of Stomatology,Hospital of Stomatology,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Stomatology,Guangzhou 510055,China;Department of Stomatology,Huizhou First Peoples Hospital,Huizhou 516003,China)

机构地区：[1]中山大学光华口腔医学院·附属口腔医院,广东省口腔医学重点实验室,广州510055 [2]惠州市第一人民医院口腔科,516003

出　　处：《中华口腔医学研究杂志（电子版）》2019年第3期166-173,共8页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：惠州市科技计划(2018Y084)~~

摘　　要：目的分析口腔颌面部手术术后谵妄(POD)的相关危险因素,为临床有效预防POD提供依据。方法检索Web of Science、PubMed、Cochrane Library、EMbase数据库,时间为数据库建库至2018年7月1日,查找关于口腔颌面部手术POD的相关文献,按照纳入、排除标准进行筛选,对纳入的文献进行质量评估,提取关于POD相关因素的数据,采用RevMan 5.3、StataSE 12.0软件进行统计学分析。结果共纳入11篇口腔颌面部手术POD的相关研究,涉及口腔颌面部手术2429例患者,其中发生POD共415例(发生率17.1%)。研究结果显示,年龄、男性、独居、精神状态、高血压、术前血红蛋白、总蛋白、术中麻醉时间、手术时间、失血量、气管切开术、术后疼痛为口腔颌面部手术POD的危险因素(P<0.05),而吸烟、酗酒、美国麻醉医师学会(ASA)分级、糖尿病、心脏病、术前血清钠、术前白蛋白、输液量、颈淋巴清扫术、皮瓣转移修复术与POD无明显相关性(P>0.05)。结论临床上口腔颌面外科医生在术前应密切关注患者的年龄、性别、精神状态、高血压及相关实验室结果(术前血红蛋白、总蛋白);术中应密切控制麻醉时间和手术时间,减少出血,维持良好通气;术后做好镇痛管理,能有效预防POD发生。Objective In order to provide evidence for the effective clinical prevention of postoperative delirium(POD),this study analyzed the related risk factors of POD after oral and maxillofacial surgery. Methods Databases including Web of Science,PubMed,Cochrane Library and EMbase were included in the searching of literatures about delirium after oral and maxillofacial surgery. The searching period was from the establishment of the databases to July 1st,2018. The literatures were screened strictly according to the included and excluded criteria,and their quality was evaluated afterwards. POD′s related factors were extracted as available data. Statistical analysis was carried out by using RevMan 5.3 and StataSE 12.0. Results In total,11 original studies with 2429 patients were included,in which 415 patients(17.1%)suffered from POD. The results showed that age,gender, solitary life, mental status, history of hypertension, preoperative hemoglobin and total protein, intraoperative anesthesia time,operation time,blood loss,tracheotomy,postoperative pain were risk factors for delirium after oral and maxillofacial surgery(P<0.05),while smoking,alcoholism,ASA scale, diabetes mellitus,heart disease,preoperative serum sodium,preoperative albumin,infusion volume,neck dissection,free flap transfer were not significantly correlated(P>0.05). Conclusions Patients′ age,gender,mental status,hypertension and related laboratory results(preoperative hemoglobin,total protein)should be paid close attention before oral and maxillofacial surgery. Factors including anesthesia time,operation time,bleeding and ventilation should be strictly controlled. Besides,postoperative analgesia should be well managed since it can effectively prevent POD.

关 键 词：口腔颌面部 手术 口腔 谵妄 手术后 

分 类 号：R782[医药卫生—口腔医学]