■神经阻滞广泛用于各种手术中,以减轻术后疼痛并促进恢复。然而,神经阻滞对谵妄的影响仍有争议。本研究旨在系统评估胸椎旁神经阻滞(TPVB)对患者在电视辅助胸腔镜手术(VATS)后谵妄发生率的影响。
■我们对PubMed进行了系统搜索,Embase,WebofScience,科克伦图书馆,和2023年6月的Scopus数据库。搜索策略结合了自由文本和医学主题词(MeSH)术语,包括围手术期认知功能障碍,谵妄,术后认知功能障碍,椎旁神经阻滞,胸外科,肺部手术,肺部手术,和食道/食道手术。我们利用随机效应模型来分析和合成效应大小。
■我们共纳入了9项RCT,涉及1,123名参与者。在VATS,TPVB显著降低术后第3天谵妄的发生率(log(OR):-0.62,95%CI[-1.05,-0.18],p=0.01,I2=0.00%)和术后第7天(log(OR):-0.94,95%CI[-1.39,-0.49],p<0.001,I2=0.00%)。此外,我们的研究表明TPVB在术后疼痛缓解中的有效性(g:-0.82,95%CI[-1.15,-0.49],p<0.001,I2=72.60%)。
■综合结果表明,在接受VATS的患者中,TPVB显著降低谵妄的发生率并且显著降低疼痛评分。
■CRD42023435528。https://www.crd.约克。AC.英国/PROSPERO。
UNASSIGNED: Nerve blocks are widely used in various surgeries to alleviate postoperative pain and promote recovery. However, the impact of nerve block on delirium remains contentious. This study aims to systematically evaluate the influence of Thoracic Paravertebral Nerve Block (TPVB) on the incidence of delirium in patients post Video-Assisted Thoracoscopic Surgery (VATS).
UNASSIGNED: We conducted a systematic search of PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases in June 2023. The search strategy combined free-text and Medical Subject Headings (MeSH) terms, including perioperative cognitive dysfunction, delirium, postoperative cognitive dysfunction, paravertebral nerve block, thoracic surgery, lung surgery, pulmonary surgery, and esophageal/esophagus surgery. We utilized a random effects model for the analysis and synthesis of effect sizes.
UNASSIGNED: We included a total of 9 RCTs involving 1,123 participants in our study. In VATS, TPVB significantly reduced the incidence of delirium on postoperative day three (log(OR): -0.62, 95% CI [-1.05, -0.18], p = 0.01, I2 = 0.00%) and postoperative day seven (log(OR): -0.94, 95% CI [-1.39, -0.49], p < 0.001, I2 = 0.00%). Additionally, our study indicates the effectiveness of TPVB in postoperative pain relief (g: -0.82, 95% CI [-1.15, -0.49], p < 0.001, I2 = 72.60%).
UNASSIGNED: The comprehensive results suggest that in patients undergoing VATS, TPVB significantly reduces the incidence of delirium and notably diminishes pain scores.
UNASSIGNED: CRD42023435528. https://www.crd.york.ac.uk/PROSPERO.