在接受非心脏手术的患者中,与术后狂妄相关的术后因素:个体患者数据元分析
Behnam Sadeghirad1,2,3, Benjamin T Dodsworth4, Nayeli Schmutz Gelsomino4,5
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
JAMA network open
|October 11, 2023
概括
手术后痴呆症 (POD) 在非心脏手术后影响了近五分之一的患者. 关键的危险因素包括年龄较大,有 Delirium 史,认知障碍,以及较高的 C 反应蛋白水平.
科学领域:
- 麻醉学 麻醉学
- 老年病的医生 老年病的医生
- 临界护理医学 临界护理医学
背景情况:
- 手术后妄 (POD) 是手术后经常发生的严重并发症.
- 虽然已知有几种导致POD的诱导因素,但它们的相对重要性和影响需要通过个人患者数据 (IPD) 分析来精确量化.
研究的目的:
- 在接受非心脏手术的成年患者中确定与POD相关的外科手术期间的因素.
- 评估这些确定因素的相对预后价值.
主要方法:
- 进行了个体患者数据 (IPD) 分析,汇集了来自21项涉及8382名患者的研究的数据.
- 多级混合效应逻辑回归被用于一阶段的元分析,缺失的数据使用链式方程归算.
- 分析重点是诊断在术后10天内出现的POD.
主要成果:
- 在综合患者队列中,POD的发病率为18%.
- POD的显著危险因素包括美国麻醉学会 (ASA) 状态4,年龄较大 (65-85岁和>85岁),低体重指数 (<18.5岁),有 Delirium 病史,手术前认知障碍和高C反应蛋白水平.
- 高等教育 (大学学位或更高) 与POD风险降低有关.
结论:
- 这项IPD元分析确定了关键的外科手术期间因素,这些因素显著增加了POD的风险.
- 这些发现可以帮助识别高风险患者,为临床实践提供信息,并教育患者和护理人员了解潜在的妄想风险.
- 进一步的研究是有必要的,以制定有效的策略,以预防妄和手术后的管理.
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