不同剂量糖皮质激素对术后神经认知功能和情绪障碍的影响：系统综述和网络荟萃分析。

IF 3.2 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research Pub Date : 2025-09-26 DOI:10.1016/j.jpsychires.2025.09.050

Yingying Fan , Jiaqi Li , Ruoyu Luo , Liwen Hao , Chaoyun Yuan , Jiyong Jing

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引用次数: 0

摘要

背景：围手术期神经认知障碍和情绪障碍已成为影响术后恢复质量的重要问题。正在进行的研究重点是确定药物干预措施，以预防术后PND和情绪障碍。围手术期广泛使用糖皮质激素；然而，它们对神经认知和心理功能的影响仍然存在争议。方法：我们对PubMed、Cochrane Library、EMBASE和Web of Science网站从建站到2024年12月30日进行了综合检索，重点关注围手术期不同剂量皮质类固醇的使用情况。结果：共有25项研究，包括17,378例患者被纳入分析。糖皮质激素显著降低术后谵妄发生率（RR = 0.85, 95% CI = 0.77 ~ 0.95, P = 0.002, I2 = 41.5%）。此外，它降低了谵妄的严重程度（SMD = -0.66, 95% CI = -0.84 ~ -0.48, P 2 = 92%）。GCs的使用（RR = 0.86, 95% CI = 0.71 ~ 1.05, P = 0.132, I2 = 25.2%）并未显著减少心境障碍的发生。在高剂量组，GCs显著降低谵妄发生率（RR = 0.79, 95% CI = 0.63 ~ 0.99）。同时，中剂量GCs显著降低了术后认知功能障碍的发生率（RR = 0.70, 95% CI = 0.37 ~ 1.35）（RR = 0.58, 95% CI = 0.36 ~ 0.92）。结论：围手术期应用糖皮质激素可显著降低术后谵妄的发生率和严重程度。不同剂量糖皮质激素对术后神经认知和心理状态的影响存在差异。围手术期给予中剂量糖皮质激素似乎更安全，并有可能预防术后神经认知功能障碍。

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Effects of different doses of glucocorticoids on postoperative neurocognitive function and mood disorders: A systematic Review and network meta-analysis

Background

Perioperative Neurocognitive Disorder and mood disorders have emerged as significant concerns impacting the quality of postoperative recovery. Ongoing research is focused on identifying pharmacological interventions to prevent postoperative PND and mood disorders. Glucocorticoids are extensively employed during the perioperative period; however, their effects on neurocognitive and psychological functions remain a matter of debate.

Methods

We conducted a comprehensive search of PubMed, Cochrane Library, EMBASE, and Web of Science from their inception to December 30, 2024, focusing on the use of various doses of corticosteroids during the perioperative period.

Results

A total of 25 studies, encompassing 17,378 patients, were included in the analysis. The administration of glucocorticoids significantly reduced the incidence of postoperative delirium (RR = 0.85, 95 %CI = 0.77 to 0.95, P = 0.002, I² = 41.5 %). Additionally, it decreased the severity of delirium (SMD = −0.66, 95 %CI = −0.84 to −0.48, P < 0.01, I² = 92 %). The use of GCs (RR = 0.86, 95 %CI = 0.71 to 1.05, P = 0.132, I² = 25.2 %) did not significantly reduce the occurrence of mood disorders. In the high-dose group, GCs significantly lowered the incidence of delirium (RR = 0.79, 95 %CI = 0.63 to 0.99). Meanwhile, medium-dose GCs notably reduced the incidence of postoperative cognitive dysfunction (RR = 0.70, 95 %CI = 0.37 to 1.35) (RR = 0.58, 95 %CI = 0.36 to 0.92).

Conclusion

The use of glucocorticoids during the perioperative period significantly reduced the incidence and severity of postoperative delirium. The effects of different doses of glucocorticoids on postoperative neurocognitive and psychological status varied. The perioperative administration of medium-dose glucocorticoids appears to be safer and has the potential to prevent postoperative neurocognitive dysfunction.

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来源期刊

Journal of psychiatric research 医学-精神病学

CiteScore

7.30

自引率

2.10%

发文量

622

审稿时长

130 days

期刊介绍： Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research: (1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors; (2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology; (3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;