外源性褪黑素及其类似物预防危重症患者谵妄效果的meta分析  

Effect of exogenous melatonin and its analogues on preventing delirium in critically ill patients:a meta-analysis

作　　者：李文瑞 李娜[1] 张志刚[1,2] 韩露露[1] 孔佳佳 王桢桢 计可欣 曾茵茹 张彩云 LI Wenrui;LI Na;ZHANG Zhigang;HAN Lulu;KONG Jiajia;WANG Zhenzhen;JI Kexin;ZENG Yinru;ZHANG Caiyun(School of Nursing,Lanzhou University,Lanzhou,Gansu 730000,P.R.China;Department of Critical Care Medicine,the First Hospital of Lanzhou University,Lanzhou,Gansu 730000,P.R.China;Outpatient Department,the First Hospital of Lanzhou University,Lanzhou,Gansu 730000,P.R.China)

机构地区：[1]兰州大学护理学院,兰州730000 [2]兰州大学第一医院重症医学科,兰州73000 [3]兰州大学第一医院门诊部,兰州730000

出　　处：《华西医学》2021年第11期1570-1577,共8页West China Medical Journal

摘　　要：目的应用meta分析评价外源性褪黑素及其类似物预防危重症患者谵妄的效果。方法计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国知网、维普、万方、中国生物医学文献数据库中的外源性褪黑素及其类似物治疗危重症患者谵妄效果的随机对照试验,试验组采用褪黑素或褪黑素类似物治疗,对照组采用安慰剂治疗。检索时限为建库至2021年1月14日。由2名研究者独立评价文献质量,采用RevMan 5.4软件进行meta分析。结果纳入11篇随机对照试验研究,纳入研究对象1177例,其中试验组588例,对照组589例。Meta分析结果显示外源性褪黑素及其类似物能降低危重症患者谵妄的发生率[比值比(odds ratio,OR)=0.45,95%置信区间(confidence interval,CI)(0.22,0.91),P=0.03],缩短机械通气时间[标准化均数差(standard mean difference,SMD)=–0.49,95%CI(–0.94,–0.03),P=0.04],对危重患者的病死率[OR=0.73,95%CI(0.46,1.17),P=0.19]和重症监护病房住院时间[SMD=–0.05,95%CI(–0.26,0.15),P=0.61]的影响无统计学意义。结论当前数据表明,外源性褪黑素及其类似物在降低危重症患者谵妄的发生率、缩短机械通气时间方面具有一定效果,对降低危重患者的病死率和重症监护病房住院时间无明显影响。以上结论还需要更多高质量研究加以证实。Objective To evaluate the effect of exogenous melatonin and its analogues on the prevention of delirium in critically ill patients by meta-analysis.Methods Randomized controlled trials of exogenous melatonin and its analogues in the prevention of delirium in critically ill patients were searched by computer from the Cochrane Library,PubMed,Web of Science,Embase,China National Knowledge Infrastructure,Chongqing VIP,Wanfang,and SinoMed databases.The trial group was treated with melatonin or its analogues,while the control group was treated with placebo.The retrieval period was from the establishment of database to January 14 th,2021.Two researchers independently evaluated the literature quality,and meta-analysis was performed using RevMan 5.4 software.Results A total of 11 randomized controlled trials containing 1177 patients were enrolled,including 588 patients in the trial group and 589 patients in the control group.The results showed that exogenous melatonin and its analogues could reduce the occurrence of delirium in critically ill patients[odds ratio(OR)=0.45,95%confidence interval(CI)(0.22,0.91),P=0.03]and shorten the time of mechanical ventilation[standard mean difference(SMD)=-0.49,95%CI(-0.94,-0.03),P=0.04],while might not affect the mortality rate[OR=0.73,95%CI(0.46,1.17),P=0.19]or length of intensive care unit stay[SMD=-0.05,95%CI(-0.26,0.15),P=0.61].Conclusions The current evidence shows that exogenous melatonin and its analogues have some effect on reducing the occurrence of delirium and shortening the duration of mechanical ventilation in critically ill patients,and have no significant effect on reducing the mortality or length of intensive care unit stay.The above conclusions need to be confirmed by more high-quality studies.

关 键 词：褪黑素 谵妄 危重症 META分析 

分 类 号：R969.4[医药卫生—药理学]