非药物干预对口腔癌患者术后谵妄预防效果的系统评价

doi:10.19438/j.cjoms.2024.03.013

摘要/Abstract

摘要： 目的：系统评价非药物干预预防口腔癌患者术后谵妄的效果,总结口腔癌患者非药物干预的主要内容,为临床决策提供依据。方法：检索8个中英文电子数据库（Embase、PubMed、Web of Science、The Cochrane Library、中国生物医学文献服务系统、中国知网、中文科技期刊数据库、万方数据知识服务平台）中有关非药物干预预防口腔癌患者术后谵妄的文献,检索时间为建库至2023年10月。主要结局指标为术后谵妄的发生率和持续时间。采用Cochrane风险偏倚评估工具评价随机对照试验,使用Review manager 5.3进行meta分析,通过敏感性分析考察异质性来源,并进行亚组分析。结果：共纳入5篇随机对照试验,患者849例。多组分非药物干预的主要内容包括加强医护人员的相关培训,术前强化宣教、熟悉ICU环境,术后睡眠管理、疼痛管理、音乐疗法、认知刺激,家属全程参与管理等内容。Meta分析结果显示,非药物干预可以降低口腔癌患者术后谵妄的总发生率[RR=0.41,95%CI：(0.31,0.54),I²=0%],降低术后谵妄的持续时间[MD=-38.51,95%CI：(-46.25,-30.77),I²=88%]。亚组分析显示,非药物干预可以降低术后第1天的谵妄发生率[RR=0.37,95%CI：(0.20,0.70),I²=0%],但对术后第2天和第3天的发生率改善作用不明显。非药物干预对术后躁动镇静评估和恢复质量均有改善作用。结论：现有证据显示,非药物干预可以降低口腔癌患者术后谵妄的总发生率和持续时间,改善躁动镇静情况和恢复质量。

关键词: 非药物干预, 预防, 术后谵妄, 口腔癌, 系统评价

Abstract: PURPOSE: To evaluate the effect of non-pharmacological interventions in preventing postoperative delirium in patients with oral cancer, summarize the main components of non-pharmacological interventions in patients with oral cancer, and aid clinical decision-making. METHODS: The literatures on the prevention of postoperative delirium by non-pharmacological interventions in patients with oral cancer were searched in 8 Chinese and English electronic databases(Embase, PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang database, VIP, China Biomedical Literature Service System). The search was conducted from inception to October 2023. The primary outcomes were the incidence and duration of postoperative delirium. Cochrane risk of bias assessment tool was used to evaluate the randomized controlled trials. Review manager 5.3 was used for meta-analysis. Heterogeneity was examined by sensitivity analysis, and subgroup analysis was performed. RESULTS: Five randomized controlled trials with 849 participants were included. The main components of multicomponent non-pharmacological interventions included enhancement of relevant training for healthcare professionals, intensive preoperative education and familiarity with ICU environment, postoperative sleep management, pain management, music therapy, cognitive stimulation, and full participation of family members. Meta-analysis showed that non-pharmacologic intervention reduced the overall incidence of postoperative delirium in oral cancer patients[RR=0.41, 95%CI:(0.31,0.54), I²=0%], decreased the duration of postoperative delirium [MD=-38.51, 95%CI:(-46.25,-30.77),I²=88%]. Subgroup analysis showed that non-pharmacologic intervention reduced the incidence of delirium on the first postoperative day[RR=0.37, 95%CI:(0.20,0.70), I²=0%], but had non-significant improvement in the incidence of delirium on the second and third postoperative day. Non-pharmacological interventions improved assessment of postoperative agitated sedation and quality of recovery. CONCLUSIONS: The current evidence shows that non-pharmacological interventions can reduce the overall incidence and duration of postoperative delirium, and improve agitated sedation and quality of recovery in oral cancer patients.

Key words: Non-pharmacological intervention, Prevention, Postoperative delirium, Oral cancer, Systematic review

中图分类号:

R739.8

王帅, 何杏芳, 王蕴洁, 吴伟勤, 黄秋雨. 非药物干预对口腔癌患者术后谵妄预防效果的系统评价[J]. 中国口腔颌面外科杂志, 2024, 22(3): 279-286.

WANG Shuai, HE Xing-fang, WANG Yun-jie, WU Wei-qin, HUANG Qiu-yu. Effectiveness of non-pharmacological interventions in preventing postoperative delirium in patients with oral cancer: a systematic review[J]. China J Oral Maxillofac Surg, 2024, 22(3): 279-286.

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