围手术期褪黑素治疗手术患者术后谵妄的疗效和安全性:一项系统综述和荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：王子君 编辑：田明德 审校：曹莹
目的:评价围手术期应用褪黑素及褪黑素激动剂预防术后谵妄(POD)的疗效和安全性。
方法:我们对截至2022年12月发表的随机对照试验(RCT)进行了系统检索。主要终点是基于POD发生率(POD- i)的疗效。次要结局包括根据住院或重症监护病房住院时间长短、住院死亡率和不良事件确定的疗效和安全性。POD-I的亚组分析基于药物类型和剂量(低剂量和高剂量褪黑素，拉梅利通)，术后时间(早期或晚期)和手术类型。
结果:在16项RCT的1981例患者分析中，治疗组POD-I低于对照组(风险比[RR] = 0.57)。高剂量褪黑素组的POD-I低于对照组(RR = 0.41)，而低剂量褪黑素和拉美替宁组没有观察到任何益处。褪黑素组术后早期(RR = 0.35)和心肺手术患者(RR = 0.54) POD-I较低。
结论:围手术期褪黑素或褪黑素激动剂治疗可抑制POD，无严重不良事件，特别是在高剂量、术后早期和心肺手术后。
文献来源：Hye Won Shin , Ji Su Kwak , Yoon Ji Choi , Jae Woo Kim , Hae Sun You , Hyun Ju Shin , Yoo Kyung Jang. Efficacy and safety of perioperative melatonin for postoperative delirium in patients undergoing surgery: a systematic review and meta-analysis. J Int Med Res. 2024 May;52(5):3000605241239854.
Efficacy and safety of perioperative melatonin for postoperative delirium in patients undergoing surgery: a systematic review and meta-analysis
Abstract
Objective: To assess the efficacy and safety of perioperative melatonin and melatonin agonists in preventing postoperative delirium (POD).
Methods: We conducted a systematic search for randomized controlled trials (RCTs) published through December 2022. The primary outcome was efficacy based on the incidence of POD (POD-I). Secondary outcomes included efficacy and safety according to the length of hospital or intensive care unit stay, in-hospital mortality, and adverse events. Subgroup analyses of POD-I were based on the type and dose of drug (low- and high-dose melatonin, ramelteon), the postoperative period (early or late), and the type of surgery.
Results: In the analysis (16 RCTs, 1981 patients), POD-I was lower in the treatment group than in the control group (risk ratio [RR] = 0.57). POD-I was lower in the high-dose melatonin group than in the control group (RR = 0.41), whereas no benefit was observed in the low-dose melatonin and ramelteon groups. POD-I was lower in the melatonin group in the early postoperative period (RR = 0.35) and in patients undergoing cardiopulmonary surgery (RR = 0.54).
Conclusion: Perioperative melatonin or melatonin agonist treatment suppressed POD without severe adverse events, particularly at higher doses, during the early postoperative period, and after cardiopulmonary surgery.Keywords: Delirium; melatonin; meta-analysis; perioperative treatment; postoperative; ramelteon; surgery.