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Penehyclidine Hydrochloride Premedication Is Not Associated with Increased Incidence of post-operative Cognitive Dysfunction or delirium:A Systemic Review and Meta-Analysis

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Chinese Medical Sciences Journal 2020年第2期35卷 121-134页

作者： Yuntai Yao Hua Ying Nengxin Fang Yongbao Zhang Xin Yuan Department of Anesthesiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100037China Department of Vascular Surgery Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100037China Department of Adult Cardiac Surgery Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100037China Department of Orthopaedics Shanghai Key Laboratory of Orthopaedic ImplantsShanghai Ninth People's HospitalShanghai Jiaotong University School of MedicineShanghai 200011China

Objective post-operative cognitive dysfunction(POCD)and post-operative delirium(POD)are two common post-operative cerebral complications.The current meta-analysis was to systematically review the effects of penehyclidine hydrochloride(PHC)on POCD and POD in surgical patients.Methods Electronic databases were searched to identify all randomized controlled trials comparing PHC with atropine/scopolamine/placebo on POCD and POD in surgical patients.Primary outcomes of interest included the incidences of POCD and POD;the secondary outcomes of interest included peri-operative minimental state examination(MMSE)scores.Two authors independently extracted peri-operative data,including patients'baseline characteristics,surgical variables,and outcome data.For dichotomous data(POCD and POD occurrence),treatment effects were calculated as odds ratio(OR)and 95%confidential interval(Cl).Each outcome was tested for heterogeneity,and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity.For continuous variables(MMSE scores),treatment effects were calculated as weighted mean difference(WMD)and 95%CI.Statistical significance was defined as P<0.05.Results Our search yielded 33 studies including 4017 patients.Meta-analysis showed that,the incidence of POCD in PHC group was comparable to that in saline group(OR=0.97;95%Ck 0.S8-1.64;P=0.92),scopolamine group(OR=0.78;95%CI:0.48-1.27;P=0.32)and atropine group(0R=1.20;95%Ch 0.86-1.67;P=0.29).The incidence of POD in PHC group was comparable to that in saline group(OR=1.53;95%CI:0.81-2.90;P=0.19)and scopolamine group(OR=0.53;95%CI:0.06-4.56;P=0.56),but higher than that in atropine group(OR=4.49;95%CI:1.34-15.01;P=0.01).Conclusions PHC premedication was not associated with increased incidences of POCD or POD as compared to either scopolamine or placebo.

关键词： penehyclidine hydrochloride post-operative cognitive dysfunction post-operative delirium meta-analysis

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Risk factors for post-operative delirium in elderly Chinese patients

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Family Medicine and Community Health 2014年第4期2卷 32-40页

作者： Xiaoli Yuan Zhixia Jiang Lingxia Song Li Yang Ying He Gongyin Luo Department Zunyi Medical College Affiliated HospitalGuizhou 563003China

Objective:The purpose of this study was to systematically analyze the risk factors for post-operative delirium(PD)in elderly patients in an effort to provide a basis for developing relevant clinical interventions in China.Methods:All published studies focusing on the risk factors for PD among elderly patients in Wanfant Data,China National Knowledge Infrastructure(CNKI),and VIP were collected accord-ing to the inclusion and exclusion criteria of this study.A meta-analysis was performed on case-control studies using RevMan5.2 software,and the incidence of PD risk factors was calculated among case series.Results:Sixteen studies,including 8 case-control studies and 8 case series,were included in the current study.There were 353 cases and 2008 controls in the case-control studies.The pooled odds ratios(95%CI)of PD risk factors were as follows:hypoxemia,2.58(1.59~4.18);pulmonary infection,4.51(2.23~9.13);hypertension,2.16(1.20~3.89);coronary heart disease,1.50(0.82~2.73);post-operative pain,3.18(1.63~6.20);general anesthesia,3.64(0.94~14.11);operative time,1.70(0.79~3.66);and senility,0.52(-0.25~1.29).The meta-analysis showed that hypoxemia,pulmonary infection,hypertension,coronary heart disease,post-operative pain,gen-eral anesthesia,operative time,and senility were significant risk factors for PD.There were 404 cases in the case series,and the incidence of hypoxemia,hypertension,general anesthesia,dia-betes mellitus,senility,coronary heart disease,pulmonary infection,and cerebrovascular disease was 62.62%,55.90%,33.7%,24.8%,16.58%,15.3%,13.9%,and 12.1%,respectively,which was much higher than other risk factors.Conclusion:Senility,hypertension,coronary heart disease,diabetes mellitus,pulmonary infection,hypoxemia,post-operative pain,and general anesthesia are significant risk factors for PD among elderly Chinese patients.

关键词： Elderly patient post-operative delirium Risk factor Systematic review Meta-analysis

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