右美托咪啶与咪达唑仑对老年患者术后谵妄影响的系统评价

摘要

Objective To evaluate the effect of Dexmedetomidine and Midazolam on postoperitive delir-ium in elderly patients by Meta-analysis. Methods Trials were collected through searches of PubMed, SCI, EM-base, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases (From the date of establishment of the data-bases to December 2013) for randomized controlled trials (RCT) on the effect of Dexmedetomidine and Midazol-am on postoperitive delirium in elderly patients. The included studies were evaluated with criteria by two research-ers independently and the extracted data were analyzed by RevMan 5.2. Results Six RCT studies involving 170 old patients met the inclusion criteria. The results of meta-analysis showed that,compared with the Midazol-am-treated patients, the prevalence of delirium was lower in Dexmedetomidine-treated patients [RR=0.17, 95%CI (0.09, 0.30), P<0.000 01]. Conclusion The incidence of delirium in Dexmedetomidine-treated patients is lower than that in the Midazolam-treated patients. However, due to the few included RCTs and small samples, especially the lower quality of included RCTs, more large-samples, high-quality RCTs are required for further verify.%目的：系统评价右美托咪定和咪达唑仑对老年患者术后谵妄的影响。方法计算机检索PubMed、SCI、EMbase、The Cochrane Library、CNKI、CBM、WanFang Data和VIP等数据库，全面收集右美托咪啶和咪达唑仑麻醉对老年患者术后谵妄影响的随机对照试验(RCT)，检索时限均为建库至2013年12月。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后，采用RevMan 5.2软件进行Meta分析。结果纳入6个RCT，共170例老年患者。Meta分析结果显示：与咪达唑仑组比较，经右美托咪定诱导后，右美托咪定组的谵妄发生率低于咪达唑[RR=0.17，95%CI (0.09，0.30)，P<0.00001]。结论咪达唑仑在老年患者术后发生谵妄率高于右美托咪啶。但鉴于纳入研究较少且样本量小，特别是质量不高，建议临床上开展大样本、多中心、高质量的随机对照试验进一步论证。