■手术后神经认知障碍(PND)在手术患者中很常见,然而,糖皮质激素预防PNDs的作用尚不清楚.本文旨在评估糖皮质激素对成年手术患者PNDs发生率的影响。
■PubMed/Medline的数据库,Embase,Cochrane图书馆,我们在Webofscience中搜索了从开始到2022年4月30日的所有可用的随机对照试验(RCT).比较糖皮质激素与安慰剂对成年手术患者(≥18岁)的PNDs发生率的影响的RCTs符合资格。进行亚组分析和荟萃回归以评估临床异质性的来源。主要结果的确定性水平由建议分级评估评估,开发和评估(等级)方法。
■确定了11项试验,共10,703名患者。与对照组相比,糖皮质激素不能降低PNDs的发生率(RR:0.84,95%CI:0.67~1.06,P=0.13,GRADE=中度).主要结局的次要分析没有改变结果。此外,糖皮质激素组ICU住院时间缩短(RR:-13.58,95%CI:-26.37~-0.80,P=0.04,GRADE=低)。然而,术后感染发生率组间无显著差异(RR:0.94,95%CI:0.84~1.06,P=0.30,GRADE=中度),血糖水平(RR:1.05,95%CI:-0.09至2.19,P=0.07,等级=低),机械通气的持续时间(RR:-2.44,95%CI:-5.47至0.59,P=0.14,等级=低),住院时间(RR:-0.09,95%CI:-0.27~0.09,P=0.33,GRADE=中度)和30天死亡率(RR:0.86,95%CI:0.70~1.06,P=0.16,GRADE=中度)。
■这项荟萃分析表明,围手术期给予糖皮质激素可能不会降低手术后PND的发生率。糖皮质激素对ICU住院时间缩短的影响有待进一步研究。未来需要使用公认的标准和经过验证的诊断工具进行高质量的试验,以确定糖皮质激素对长期PND的影响。
■https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022302262,标识符:CRD42022302262。
UNASSIGNED: Postoperative neurocognitive disorders (PNDs) is common among surgical patients, however, the effect of glucocorticoids for preventing PNDs is not clear. This review aims to evaluate the effect of glucocorticoids on the incidence of PNDs in adult patients undergoing surgery.
UNASSIGNED: The databases of PubMed/Medline, Embase, the Cochrane Library, and Web of science were searched for all available randomized controlled trials (RCTs) from inception to April 30, 2022. RCTs comparing the effect of glucocorticoids with placebo on the incidence of PNDs in adult surgical patients (≥18 years old) were eligible. Subgroup analyses and meta-regressions were performed to evaluate sources of clinical heterogeneity. The level of certainty for main outcomes were assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
UNASSIGNED: Eleven trials with a total of 10,703 patients were identified. Compared with the control group, glucocorticoids did not reduce the incidence of PNDs (RR: 0.84, 95% CI: 0.67 to 1.06, P = 0.13, GRADE = moderate). Secondary analyses for primary outcome did not change the result. In addition, the length of ICU stay was decreased in glucocorticoids group (RR: -13.58, 95% CI: -26.37 to -0.80, P = 0.04, GRADE = low). However, there were no significant differences between groups with regards to the incidence of postoperative infection (RR: 0.94, 95% CI: 0.84 to 1.06, P = 0.30, GRADE = moderate), blood glucose level (RR: 1.05, 95% CI: -0.09 to 2.19, P = 0.07, GRADE = low), duration of mechanical ventilation (RR: -2.44, 95% CI: -5.47 to 0.59, P = 0.14, GRADE = low), length of hospital stay (RR: -0.09, 95% CI: -0.27 to 0.09, P = 0.33, GRADE = moderate) and 30-day mortality (RR: 0.86, 95% CI: 0.70 to 1.06, P = 0.16, GRADE = moderate).
UNASSIGNED: This meta-analysis suggests that perioperative administration of glucocorticoids may not reduce the incidence of PNDs after surgery. The effect of glucocorticoids on decreased length of ICU stay needs further researches. Future high-quality trials using acknowledged criteria and validated diagnostic tools are needed to determine the influence of glucocorticoids on long-term PNDs.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302262, identifier: CRD42022302262.