预防谵妄的乙酰胆碱酯酶抑制剂:系统回顾和荟萃分析。

IF 6 1区 医学 Q1 CRITICAL CARE MEDICINE
Leonardo Zumerkorn Pipek, Giovanna Salema Pascual, Rafaela Farias Vidigal Nascimento, Guilherme Diogo Silva, Luiz H Castro
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引用次数: 0

摘要

目的:谵妄是住院患者的常见并发症,特别是在老年人中,并与显著的发病率和死亡率相关。乙酰胆碱酯酶抑制剂(AChEIs)被认为是减少谵妄发生和严重程度的潜在药物。本研究旨在评价乙酰胆酸抑制剂预防和治疗住院患者谵妄的疗效。数据来源:检索PubMed, Embase和Web of Science。该研究已在PROSPERO注册(CRD42024563798)。研究选择:比较AChEIs和安慰剂治疗住院患者谵妄的研究。数据提取:主要结局是谵妄的发生,次要结局包括持续时间、严重程度和住院时间(LOS)。资料综合:根据谵妄的预防或治疗进行亚组分析。采用RStudio 4.4.0进行统计学分析,采用随机效应模型,I2评估异质性。偏倚风险2用于偏倚评估。我们筛选了1306份记录,包括10项研究:8项研究关注手术后的预防,2项研究关注已建立的谵妄的治疗。共有731名患者被分析:365名AChEIs组和366名安慰剂组。AChEIs显著降低谵妄发生(风险比= 0.68 [0.47-0.98];P = 0.039)。谵妄持续时间无显著影响(平均差[MD] = -0.16 d [-0.9 ~ 0.62 d];p = 0.23),谵妄严重程度(标准化平均差[SMD] = -0.08[-0.58至0.41];p = 0.74)或LOS (MD = -0.82 d [-2.03 ~ 0.40 d];P = 0.19)。亚组分析显示,当使用乙酰氨基酚类药物作为预防药物时,结果有更好的趋势,该亚组谵妄持续时间显著减少(SMD= -0.32[-0.56至-0.07];P < 0.01)。在不良事件方面没有发现显著差异。结论:选择性手术患者预防性使用乙酰胆碱酯酶可有效减少谵妄的发生。乙酰胆碱抑制剂对谵妄持续时间、严重程度或住院LOS无显著影响。需要进一步的研究来探索不同患者群体和环境中achei的潜在益处或危害。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acetylcholinesterase Inhibitors for Delirium Prevention: A Systematic Review and Meta-Analysis.

Objectives: Delirium is a frequent complication in hospitalized patients, particularly in older adults, and is associated with significant morbidity and mortality. Acetylcholinesterase inhibitors (AChEIs) have been proposed as potential agents to reduce occurrence and severity of delirium. This study aimed to evaluate the efficacy of AChEIs for both prophylaxis and treatment of delirium in hospitalized patients.

Data sources: We searched PubMed, Embase, and Web of Science. The study was registered on PROSPERO (CRD42024563798).

Study selection: Studies comparing AChEIs and placebo for delirium in hospitalized patients.

Data extraction: The main outcome of interest was delirium occurrence, while secondary outcomes included duration, severity, and hospital length of stay (LOS).

Data synthesis: Subgroup analyses were performed based on prophylaxis or treatment of delirium. Statistical analysis was performed in RStudio 4.4.0 with a random effects model, and heterogeneity was assessed with I2. Risk of Bias 2 was used for bias assessment. We screened 1306 records and included ten studies: eight studies focusing on prophylaxis after surgery and two on treatment of established delirium. A total of 731 patients were analyzed: 365 in the AChEIs group and 366 in the placebo group. AChEIs significantly reduced delirium occurrence (risk ratio = 0.68 [0.47-0.98]; p = 0.039). No significant effects were observed for delirium duration (mean difference [MD] = -0.16 d [-0.9 to 0.62 d]; p = 0.23), delirium severity (standardized mean difference [SMD] = -0.08 [-0.58 to 0.41]; p = 0.74), or LOS (MD = -0.82 d [-2.03 to 0.40 d]; p = 0.19). Subgroup analysis showed a tendency for better outcomes when AChEIs were used as prophylaxis, with a significant reduction in delirium duration in this subgroup (SMD= -0.32 [-0.56 to -0.07]; p < 0.01). No significant differences in adverse events were identified.

Conclusions: AChEIs are effective in reducing occurrence of delirium when used prophylactically in patients undergoing elective surgery. AChEIs did not significantly impact on delirium duration, severity, or hospital LOS. Further studies are needed to explore the potential benefits or harms of AChEIs in different patient populations and settings.

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来源期刊
Critical Care Medicine
Critical Care Medicine 医学-危重病医学
CiteScore
16.30
自引率
5.70%
发文量
728
审稿时长
2 months
期刊介绍: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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