老年髋部手术后谵妄发病率的Meta分析

目的:采用 Meta分析综合评价老年髋部手术术后谵妄的发病率。方法:检索2004年1月1日至2013年12月31日Pubmed数据库有关老年髋部手术术后谵妄发病率的临床研究文献。按照文献的纳入及排除标准进行文献的筛选,制定文献摘录表;采用Stata-12.0进行Meta分析。计算I2以检验研究之间的异质性,当I2>50%时,采用随机效应模型。按照年龄阶段、谵妄评估量表及文献统计区域进行亚组分析。各文献采用Begg方法检验发表偏倚。结果:最终纳入21篇文献。加权合并的老年髋部手术术后谵妄发病率为17%95%CI(16%,18%)].其中纳入的5篇文献中髋部择期手术术后谵妄发病率与髋部急诊手术相比明显降低OR=0.32,95%CI (22%,45%)].小于80岁与大于80岁的谵妄发病率分别为21%95%CI(19%,23%)]和21%95%CI(19%,24%)];CAM与其他评定量表的谵妄发病率分别为23%95%CI(21%,26%)]和19%95%CI(17%,21%)];亚洲区域与欧美区域的谵妄发病率分别为17%95%CI(15%,20%)]和23%95%CI(21%,25%)].Begg方法检验未见明显发表偏倚(P<0.05).结论:老年髋部术后谵妄发病率较高,尤其在于急诊术后。为了利于老年术后谵妄发病率的评估、降低异质性及可能的发表偏倚,需要制定更标准化的研究方法。

Iincidence of postoperative delirium after hip surgery in elderly patients:a meta-analysis

Objective:To evaluate incidence of postoperative delirium after hip surgery in elderly patients by meta-analysis. Methods:From January 1,2014 to December 31,2013,clinical literatures about postoperative delirium after hip surgery in elderly patients,were searched from the Pubmed. Literature extract table were formed according to inclusion and exclusion criteria. Stata-12.0 was applied for Meta-analysis. I² was used to test heterogeneity of study,random-effect model was performed when I²>50%. Subgroup analysis was used according to stage of age,assessment scale of delirium and statistical area of literature. Begg test was used to test publication bias. Results:Twenty-one literatures were included. Incidence of postoperative delirium after hip surgery in elderly patients by weighted and combination was 17%95%CI (16%,18%)]. Incidence of postoperative delirium after optional hip surgery was decreased more than emergency operation in included 5 literaturesOR=0.32,95%CI (0.22,0.45)]. Incidence of postoperative delirium in patients less than 80 years old was 21%95%CI(19%,23%)],while 21%95%CI(19%,24%)] in patients more than 80 years old. Incidence of postoperative delirium in CAM evaluation scale was 23%95%CI(21%,26%)],while 19%95%CI(17%,21%)] in other evaluation scales. Incidence of postoperative delirium in Asian area was 17%95%CI(15%,20%)],while 23%95%CI(21%,25%)] in European and American area. There was no publication bias tested by Begg test(P<0.05). Conclusion:Incidence of postoperative delirium after hip surgery in elderly patients increases higher,especially in emergency operation. A standardizing research method is benefit for evaluate incidence of postoperative delirium after hip surgery in elderly patients,decreasing heterogeneity and publication bias.