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中华危重症医学杂志(电子版) ›› 2020, Vol. 13 ›› Issue (03) : 200 -206. doi: 10.3877/cma.j.issn.1674-6880.2020.03.008

所属专题: 文献

荟萃分析

氟哌啶醇预防危重症患者谵妄发生的Meta分析
王倩1, 赵阳2,(), 臧彬2   
  1. 1. 110000 沈阳,中国医科大学附属盛京医院ICU(现工作单位为中国医科大学附属第四医院急诊科)
    2. 110000 沈阳,中国医科大学附属盛京医院ICU
  • 收稿日期:2019-12-25 出版日期:2020-06-01
  • 通信作者: 赵阳

Preventive effect of haloperidol on delirium in critically ill patients: a meta-analysis

Qian Wang1, Yang Zhao2,(), Bin Zang2   

  1. 1. Department of Intensive Care Unit, Shengjing Hospital of China Medical University, Shengyang 110000, China (Wang Qian, currently working in the Department of Emergency Medicine, the Fourth Affiliated Hospital of China Medical University)
    2. Department of Intensive Care Unit, Shengjing Hospital of China Medical University, Shengyang 110000, China
  • Received:2019-12-25 Published:2020-06-01
  • Corresponding author: Yang Zhao
  • About author:
    Corresponding author: Zhao Yang, Email:
引用本文:

王倩, 赵阳, 臧彬. 氟哌啶醇预防危重症患者谵妄发生的Meta分析[J]. 中华危重症医学杂志(电子版), 2020, 13(03): 200-206.

Qian Wang, Yang Zhao, Bin Zang. Preventive effect of haloperidol on delirium in critically ill patients: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(03): 200-206.

目的

系统评价氟哌啶醇预防危重患者发生谵妄的疗效和安全性。

方法

计算机检索Medline、EMbase、The Cochrane Library、维普数据库、中国知网、中国生物医学文献数据库数据库从建库至2018年9月的关于氟哌啶醇预防危重症患者谵妄疗效的随机对照试验(RCT)。由2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

共纳入4个RCT,2 455例患者。Meta分析结果显示,试验组与对照组危重症患者间28 d谵妄发病率[相对危险度(RR) = 0.96,95%置信区间(CI)(0.65,1.43),Z = 0.19,P = 0.85]、28 d无谵妄及无昏迷时间[均数差(MD) = 0.05,95%CI(-0.06,0.15),Z = 0.88,P = 0.38]、28 d存活率[RR = 1.00,95%CI(0.97,1.04),Z = 0.23,P = 0.82]、ICU住院时间[MD = -0.18,95%CI(-2.00,1.64),Z = 0.20,P = 0.84]的比较,差异均无统计学意义。且在严重不良反应方面,两组患者间QTc间期延长[RR = 1.18,95%CI(0.83,1.67),Z = 0.92,P = 0.36]、锥体外系症状[RR = 1.07,95%CI(0.69,1.67),Z = 0.31,P = 0.76]、过度镇静[RR = 1.90,95%CI(0.77,4.66),Z = 1.40,P = 0.16]发生的比较,差异也均无统计学意义。

结论

氟哌啶醇不能预防危重症患者谵妄的发生,且对预后也没有明显改善作用。

Objective

To systemically evaluate the preventive effect of haloperidol on delirium in critically ill patients and its safety.

Methods

The Medline, EMbase, Cochrane Library, VIP, CNKI and CBM databases were searched for randomized controlled trials (RCTs) about the preventive effect of haloperidol on delirium in critically ill patients published up to September 2018. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software.

Results

Totally 4 RCTs involving 2 455 patients were included in this study. Meta-analysis showed that the 28-d delirium incidence [relative risk (RR) = 0.96, 95% confidence interval (CI) (0.65, 1.43), Z = 0.19, P = 0.85], delirium-free and coma-free days within 28 days [mean difference (MD) = 0.05, 95%CI (-0.06, 0.15), Z = 0.88, P = 0.38], 28-d survival rate [RR = 1.00, 95%CI (0.97, 1.04), Z = 0.23, P = 0.82] and ICU length of stay [MD = -0.18, 95%CI (-2.00, 1.64), Z = 0.20, P = 0.84] all showed no significant differences between the haloperidol group and control group. Moreover, there were no statistically significant differences in the QTc interval prolongation [RR = 1.18, 95%CI (0.83, 1.67), Z = 0.92, P = 0.36], extrapyramidal symptoms [RR = 1.07, 95%CI (0.69, 1.67), Z = 0.31, P = 0.76] and excessive sedation [RR = 1.90, 95%CI (0.77, 4.66), Z = 1.40, P = 0.16] between the two groups.

Conclusion

Haloperidol cannot prevent delirium in critically ill patients or improve their prognosis.

表1 纳入研究的基本特征
表2 纳入研究的方法学质量评价
图1 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者谵妄发病率影响的森林图
图2 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者28 d无谵妄及无昏迷时间影响的森林图
图3 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者28 d存活率影响的森林图
图4 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者ICU住院时间影响的森林图
图5 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者严重不良反应影响的森林图
图6 纳入研究的发表偏倚风险的漏斗图
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