背景:尽管先前的综述说明了褪黑激素受体激动剂(MRAs)预防谵妄的功效,最近的一些随机对照试验(RCT)未证实这些效应.
目的:本研究系统评价了疗效,可接受性,MRA对谵妄预防的耐受性。
方法:我们搜索了电子数据库,包括Scopus,PubMed,CINAHL,和受控试验登记册,从成立到2022年2月20日。主要疗效结果是MRA给药后谵妄发生率;相对风险(RRs),整体停药,以及因不良事件而停药的情况也被提出.
结果:MRA治疗组和安慰剂治疗组的谵妄总合并发生率有显著差异,RR(95%CI)=0.66(0.52,0.84),I2=59%。同样,褪黑素治疗组的发病率显著低于安慰剂治疗组[RR(95%CI)=0.65(0.49,0.88),I2=65%]。不幸的是,ramelteon治疗组和安慰剂治疗组的发病率无显著差异[RR(95%CI)=0.67(0.42,1.08),I2=50%]。褪黑素或拉美托治疗组的谵妄发生率与老年患者的安慰剂治疗组没有显着差异。褪黑素治疗组的谵妄合并发生率明显低于苯二氮杂酮治疗组。
结论:基于这篇综述,褪黑激素可以预防谵妄,效果很小。然而,ramelteon没有显示出预防谵妄的功效.此外,褪黑素和ramelteon均未单独显示出预防老年患者谵妄的有效性。因此,在临床实践中使用MRA预防谵妄应谨慎。然而,未来明确的大样本量研究可以验证这些发现.
BACKGROUND: Although a previous
review illustrated the efficacy of melatonin receptor agonists (MRAs) in preventing delirium, some recent randomized controlled trials (RCTs) did not confirm these effects.
OBJECTIVE: This study systematically reviewed the efficacy, acceptability, and tolerability of MRAs for delirium prevention.
METHODS: We searched electronic databases, including Scopus, PubMed, CINAHL, and Controlled Trials Register, from their inception to February 20, 2022. The primary efficacy outcome was delirium incidence rate after MRA administration; relative risks (RRs), overall discontinuation, and discontinuation due to adverse events are also presented.
RESULTS: The overall pooled incidence rates of delirium in MRA-treated and placebo-treated groups were significantly different with RR (95% CI)=0.66(0.52, 0.84, ), I2=59%. Similarly, the incidence rate was significantly lower in the melatonin-treated group than in the placebo-treated group [RR (95% CI) =0.65 (0.49, 0.88), I2=65%]. Unfortunately, incidence rates were not significantly different between ramelteon-treated and placebo-treated groups [RR (95% CI) =0.67 (0.42, 1.08), I2=50%]. The pooled incidence rate of delirium in either melatonin or ramelteon-treated groups was not significantly different from the placebo-treated group in elderly patients. The pooled incidence rate of delirium was significantly lower in the melatonin-treated group than in the benzodiazepinetreated group.
CONCLUSIONS: Based on this
review, melatonin could prevent delirium with a small effect size. However, ramelteon did not show efficacy in preventing delirium. Additionally, neither melatonin nor ramelteon individually showed effectiveness in preventing delirium in elderly patients. Therefore, using MRAs to prevent delirium in clinical practice should be cautious. However, future welldefined and large sample size studies could verify these findings.