Effectiveness of drug interventions to prevent delirium after surgery for older adults: systematic review and network meta-analysis of randomised controlled trials.

Methods

Systematic reviewand network meta-analysis.

系统评价和网络荟萃分析。

data_sources

Embase, Medline, and Cochrane Library up to 4 March 2024.

截至2024年3月4日，检索了Embase、Medline和Cochrane图书馆。

eligibility_criteria

Randomised controlled trials with administration of one or more drugs for the prevention of delirium after surgery requiring general or regional anaesthesia that recruited participants at least 60 years old and used a validated delirium assessment tool to measure the outcome.

随机对照试验，使用一种或多种药物预防全身或区域麻醉手术后出现的谵妄，招募的参与者至少60岁，并使用经过验证的谵妄评估工具来测量结果。

Surgery under local anaesthesia only, preoperative mechanical ventilation, and studies of interventions to treat delirium were excluded.

仅在局部麻醉下进行的手术、术前机械通气以及旨在治疗谵妄的干预措施研究被排除在外。

data_extraction_and_synthesis

Assessors masked to each other's decisions screened studies, extracted data, and assessed risk of bias and quality of evidence in duplicate by using the Cochrane risk of bias tool version 2 and the CINeMA tool.

评估者相互遮蔽决策，使用Cochrane风险偏倚工具版本2和CINeMA工具，以双重方式筛选研究、提取数据并评估偏倚风险和证据质量。

Bayesian arm based network meta-analysiswas used to compare interventions.

采用贝叶斯基于臂的网络荟萃分析比较不同干预措施。

Results

158 trials were identified with 41 084 participants comparing 52 drug interventions.

共识别出158项试验，涉及41,084名参与者，比较了52种药物干预措施。

Seventeen trials were rated as being at high risk of bias.

有17项试验被评为存在高偏倚风险。

The overall risk of delirium after surgery was 14.5% (n=5957).

术后总体发生谵妄的风险为14.5%（n=5957）。

Dexmedetomidine (odds ratio 0.46, 95% credible interval 0.36 to 0.57), corticosteroids (0.53, 0.31 to 0.87), melatonin receptor agonists (0.54, 0.34 to 0.85), parecoxib (0.34, 0.16 to 0.74), olanzapine (0.27, 0.07 to 0.94), and intranasal insulin (0.13, 0.04 to 0.34) were the most effective interventions at preventing delirium in trials not at high risk of bias.

右美托咪定（优势比 0.46, 95% 置信区间 0.36 至 0.57），糖皮质激素（0.53, 0.31 至 0.87），褪黑素受体激动剂（0.54, 0.34 至 0.85），帕瑞昔布（0.34, 0.16 至 0.74），奥氮平（0.27, 0.07 至 0.94），以及鼻腔内胰岛素（0.13, 0.04 至 0.34）是在没有高度偏倚风险的试验中预防谵妄最有效的干预措施。

Only corticosteroids reduced the severity of delirium (mean difference -2.42 (95% credible interval -4.72 to -0.12) Memorial Delirium Assessment Scale points).

只有糖皮质激素减少了谵妄的严重程度（平均差异 -2.42 (95% 置信区间 -4.72 至 -0.12) 记忆障碍评估量表点数）。

Most interventions had no effect on length of stay, mortality, cognition, or quality of life.

大多数干预措施对住院时间、死亡率、认知功能或生活质量没有影响。

Hypotension and bradycardia were more common with dexmedetomidine, but postoperative nausea and vomiting were reduced.

使用右美托咪定时低血压和心动过缓更为常见，但术后恶心和呕吐有所减少。

Postoperative infection rates were not increased by corticosteroids.

皮质类固醇并未增加术后感染率。

Conclusions

Dexmedetomidine is effective in the prevention of postoperative delirium.

右美托咪定在预防术后谵妄方面是有效的。

This finding remains after exclusion of studies at high risk of bias.

在排除了高偏倚风险的研究后，这一发现仍然成立。

Corticosteroids, melatonin receptor agonists, parecoxib, intranasal insulin, and olanzapine have potential benefit, although evidence is of moderate to very low quality.

皮质类固醇、褪黑激素受体激动剂、帕瑞昔布、鼻腔内胰岛素和奥氮平可能有益，尽管证据质量从中等到非常低。

Evidence synthesis in this area is complicated by inadequate trial registration practices and incomplete adoption of core outcome sets.

该领域的证据综合因试验注册实践不足和核心结果集采纳不全面而变得复杂。

systematic_review_registration

PROSPERO CRD42023488337.

PROSPERO CRD42023488337。