右美托咪定对心脏外科术后谵妄影响的荟萃分析  

The effect of dexmedetomidine use on delirium in patients undergoing cardiac surgery:A Meta-analysis

作　　者：张伟 张敏 武海波 李进华[2] ZHANG We;ZHANG Min;WU Haibo;LI Jinhua(Department of Cardiothoracic Surgery,Changzhi City People's Hospital,Changzhi 046000,China)

机构地区：[1]长治市人民医院心胸外科,046000 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科

出　　处：《心肺血管病杂志》2025年第1期85-90,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：中华医学会杂志社护理学科研究课题。

摘　　要：目的:通过荟萃分析探讨右美托咪定对心脏外科术后谵妄及其他临床结果的影响。方法:系统检索PUBMED、Embase、Cochrane Library及相关文章的参考文献,搜集2022年9月26日之前,关于右美托咪定对心脏外科术后谵妄影响的已发表文献。主要临床结局是心脏术后谵妄,次要临床结局包括住院死亡、谵妄时间、机械通气时间、ICU滞留时间、住院时间、心动过缓、低血压。用R version4.1.3软件进行结果合并。结果:共有11文献入选,共纳入2 958例患者,其中右美托咪定组1 480例,对照组1 478例。右美托咪组谵妄的发生率为14.0%,对照组为16.4%。两组心脏术后谵妄时间(MD=-0.99,95%CI:-2.20~0.21,P=0.106)、心动过缓发生率(RR=1.20,95%CI:0.91~1.57,P=0.201)及低血压发生率差异无统计学意义(RR=0.90,95%CI:0.57~1.44,P=0.674)。与对照组相比,右美托咪定似乎降低了谵妄发生率(RR=0.72,95%CI:0.52~1.00,P=0.050),显著降低患者的住院死亡率(RR=0.42,95%CI:0.22~0.79,P=0.007),显著缩短机械通气时间(MD=-1.59,95%CI:-2.83~-0.35,P=0.012)、ICU滞留时间(MD=-2.78,95%CI:-4.55~-1.01,P=0.002)及住院时间(MD=-1.49;95%CI:-2.45~-0.52,P=0.003)。结论:右美托咪定降低心脏外科术后患者谵妄的发生率,进而显著缩短了住院时间。Objective:To evaluate the effect of dexmedetomidine use on delirium and other clinical outcomes in patients undergoing cardiac surgery.Methods:Systematic searches using PubMed,Embase,and the Cochrane Library were carried out for articles published from inception to September 26,2022.The primary outcome was incidence of delirium after cardiac surgery.The secondary outcomes included the length of delirium,mortality,bradycardia,hypotension,the length of ICU and hospital stay,and the duration of mechanical ventilation.R version 4.0.3 software was used to pooled the outcomes.Results:Eleven trials totaling 2958 patients(1480 randomized to dexmedetomidine therapy and 1478 to non-dexmedetomidine therapy)were included.In the dexmedetomidine group incidence of delirium was 14.0%,compared with 16.4%in the control group.there were no differences the length of delirium(MD=-0.99,95%CI:-2.20-0.21,P=0.106),the incidence of bradycardia(RR=1.20,95%CI:0.91-1.57,P=0.201),the incidence of hypotension(RR=0.90,95%CI:0.57-1.44,P=0.674).However,dexmedetomidine use significantly reduced the incidence of delirium(RR=0.72,95%CI:0.52-1.00,P=0.050),the in-hospital mortality(RR=0.42,95%CI:0.22-0.79,P=0.007),the duration of mechanical ventilation(MD=-1.59,95%CI:-2.83--0.35,P=0.012),length of ICU stay(MD=-2.78,95%CI:-4.55--1.01,P=0.002),and length of hospital stay(MD=-1.49,95%CI:-2.45--0.52,P=0.003).Conclusions:Dexmedetomidine use decreased the incidence of delirium and length of hospital stay in patients undergoing cardiac surgery.

关 键 词：右美托咪定 心脏外科 谵妄 荟萃分析 

分 类 号：R54[医药卫生—心血管疾病]