目的:本荟萃分析旨在评估髂筋膜腔阻滞(FIB)是否能降低老年髋部手术患者术后谵妄(POD)的发生率。
方法:该荟萃分析已在国际前瞻性系统评价注册(PROSPERO;CRD42023490399)中注册。PubMed,Embase,WebofScience,和CochraneLibrary数据库搜索随机对照试验(RCT),直至2023年11月15日。使用ReviewManger5.4分析数据。
结果:共有10个RCTs,930名老年患者纳入了该荟萃分析。这项荟萃分析表明,FIB可以降低未发生术前认知障碍的老年髋关节手术患者POD的发生率(OR:0.46;95CI[0.22,0.96],P=0.04,I2=0%)。POD发生率的亚组分析表明,进入手术室前接受FIB治疗的老年患者发生POD的风险较低(OR:0.48;95CI[0.30,0.76],P=0.002,I2=0%),FIB可以减少椎管内麻醉而不是全身麻醉患者POD的发生(OR:0.37;95CI[0.20,0.66],P﹤0.01,I2=0%)。此外,FIB可以降低术后第一天的MMSE评分(SMD:1.07;95CI[0.15,1.99],P=0.02,I2=86%)。此外,FIB可以降低术后第一天和第三天的疼痛评分(SMD:-0.46;95CI[-0.74,-0.18],P=0.001,I2=43%;SMD:-0.62;95CI[-0.97,-0.26],P﹤0.001,I2=58%),以及身体活动后(SMD:-1.64;95CI[-3.00,-0.28],P=0.02,I2=83%)。
结论:FIB可以降低老年髋关节手术患者POD的发生率,而不存在认知障碍。此外,它可以降低谵妄评分和疼痛评分。
OBJECTIVE: This meta-analysis aimed to evaluate whether fascia iliaca compartment block (FIB) could reduce the incidence of postoperative delirium (POD) in elderly patients undergoing hip surgery.
METHODS: This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023490399). The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) till November 15, 2023. Review Manger 5.4 was used to analyze the data.
RESULTS: A total of 10 RCTs with 930 elderly patients were included in this meta-analysis. This meta-analysis indicated that FIB could reduce the incidence of POD in elderly patients undergoing hip surgery without preoperative cognitive impairment (OR:0.46; 95%CI[0.22, 0.96], P = 0.04, I2 = 0%). Subgroup analysis of the incidence of POD showed that elderly patients who received FIB treatment before entering the operating room had a lower risk of developing POD(OR:0.48; 95%CI[0.30, 0.76], P = 0.002, I2 = 0%), and FIB could reduce the occurrence of POD in patients undergoing intravertebral anesthesia instead of general anesthesia (OR:0.37; 95%CI[0.20, 0.66], P﹤0.01, I2 = 0%). Moreover, FIB could reduce the MMSE score on the first day after surgery (SMD:1.07; 95%CI[0.15, 1.99], P = 0.02, I2 = 86%). In addition, FIB could reduce the pain score on the first and third day after surgery (SMD: -0.46; 95%CI[-0.74, -0.18], P = 0.001, I2 = 43%; SMD: -0.62; 95%CI[-0.97, -0.26], P﹤0.001, I2 = 58%), as well as after physical activity(SMD: -1.64; 95%CI[-3.00, -0.28], P = 0.02, I2 = 83%).
CONCLUSIONS: FIB can reduce the incidence of POD in elderly patients undergoing hip surgery without pre-existing cognitive impairment. Additionally, it can lower the delirium scores and pain scores.