帕瑞昔布对全身麻醉老年非心脏手术患者术后认知功能影响的Meta分析

目的 采用Meta分析方法系统评价帕瑞昔布对老年患者非心脏手术术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响.方法 计算机检索PubMed、EMBASE、The Cochrane Library、中国知网、维普、万方、中国生物医学文献数据库,查找帕瑞昔布对老年全身麻醉非心脏手术患者早期POCD影响的随机对照试验,检索时限均为从建库至2016年7月30日.按照纳入与排除标准筛选文献、提取资料,按改良Jadad评分进行质量评价,应用RevMan5.2软件进行Meta分析.结果 最终纳入17篇文献、18项随机对照试验(randomized controlled trial,RCT),共计1082例患者.Meta分析结果显示:与对照组比较,帕瑞昔布可以减少术后3 d POCD发生率[相对危险度(relative risk,RR)=0.50,95%CI=0.37~0.68],但对术后7 d POCD发生率无明显影响(RR=0.71,95%CI=0.49~1.04).帕瑞昔布提高患者术后1 d[均数差(mean difference,MD)=1.2,95%CI=0.39~2.02]、3 d(MD=0.97,95%CI=0.44~1.51)简易智力状态检查(mini-mental state examinatlon,MMSE)评分,对术后7 d的MMSE评分(MD=0.17,95%CI=-1.02~1.36)无明显影响.结论 目前文献Meta分析结果显示:麻醉期间给予帕瑞昔布可以暂时提高患者MMSE评分,改善认知功能,但对术后7 d认知功能无明显影响.

Effects of parecoxib on postoperative cognitive function in elderly patients after receiving noncardiac surgery undergoing general anesthesia:a Meta-analysis

Objective Using Meta-analysis to systematically evaluate the impact of parecoxibon on postoperative cognitive dysfunction (POCD) of senior patients after non-cardiac surgery. Methods Literature on the impact of parecoxibon on POCD of senior patients after non-cardiac surgery using randomized controlled trial (RCT) are searched from the following databases:PubMed, EMBASE, The Cochrane Library, CNKI, VIP, WanFangData, Chinese Biomedical Literature Database. All literature from the database until 2016 July 30th are included in the search. The studies were further selected based on incorporation and exclusion criteria. The data quality was evaluated based on improved Jadad scales. The meta-analysis was performed using RevMan5.2 software. Results 18 RCT studies from 17 publications, coming from 1082 patients, were included in the analysis. The results of meta-analysis shows that:compared to control group, parecoxib can reduce the rate of POCD 3 day post-surgery (RR=0.50,95%CI=0.37-0.68), but not 7 day post-surgery[relative risk(RR)=0.71,95%CI=0.49-1.04]. Parecoxib can increase the MMSE score of patients 1 day post-surgery [mean difference(MD)=1.2,95%CI=0.39-2.02] and 3 day post-surgery (MD=0.97,95%CI=0.44-1.51), but has no significant effect on 7 day post-surgery MMSE score (MD=0.17,95%CI=-1.02-1.36). Conclusions The literature suggests that parecoxib can increase MMSE score and improve post-surgery cognitive function temporally, but has no significant effect on post-surgery cognitive function after 7 day post-surgery.