TURP术后谵妄危险因素的Meta分析

Meta-Analysis of Risk Factors for Post-TURP Delirium

摘要: 目的：系统评价前列腺患者经尿道电切术后发生谵妄的危险因素，为临床决策提供参考。方法：通过PubMed、Embase、The Cochrane Library、Web of Science、CNKI、万方数据库、维普数据库、CBM等数据库检索关于经尿道前列腺电切术后谵妄危险因素的相关文献。检索时限均为建库至2023年3月31日。按照纳入与排除标准对获得的文献独立进行文献筛选、资料提取，采用NOS量表进行质量评价，采用Review Manager 5.3软件进行Meta分析。结果：本研究共纳入689篇文献，共4495例患者，术后发生谵妄的患者为309例，发生率为6.87%。Meta分析结果显示：年龄[OR = 2.64, 95% CI (1.35~5.17), P = 0.06]、基础疾病[OR = 4.57, 95% CI (3.09~6.78), P < 0.0001]、膀胱痉挛[OR = 2.67, 95% CI (2.24~3.19), P = 0.03]、缺氧[OR = 3.33, 95% CI (2.15~5.20), P = 0.003]、电解质紊乱[OR = 7.71, 95% CI (5.71~10.41), P = 0.09]、睡眠障碍[OR = 5.50, 95% CI (3.49~9.63), P = 0.07]是TURP后发生谵妄的危险因素。结论：现有证据表明，年龄、基础疾病、术后膀胱痉挛、电解质紊乱、缺氧、睡眠障碍是患者术后发生谵妄的危险因素，在临床实践中，医务人员应重视这些危险因素，对TURP术后患者需加强观察，做到早评估、早干预、早治疗，减轻患者认知功能损害，提高老年人生活质量，但受到文献质量的限制，研究结果的真实性亟待更多高质量研究来进行进一步验证。

Abstract: Objective: To systematically evaluate the risk factors for delirium after transurethral electrodessication of the prostate in prostate patients, and to provide a reference for clinical decision-making. Methods: Relevant literature on the risk factors for delirium after transurethral resection of the prostate was searched through PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang Database, Wikipedia, CBM and other databases. The timeframe for all searches was from the establishment of the database to 31 March 2023. The literature was independently screened and extracted according to the inclusion and exclusion criteria, and quality assessment was performed using the NOS scale, and meta-analysis was performed using Review Manager 5.3 software. Results: A total of 689 papers with 4495 patients were included in this study, and the number of patients with postoperative delirium was 309, with an incidence rate of 6.87%. Meta-analysis showed that age [OR = 2.64, 95% CI (1.35~5.17), P = 0.06], underlying disease [OR = 4.57, 95% CI (3.09~6.78), P < 0.0001], bladder spasms [OR = 2.67, 95% CI (2.24~3.19), P = 0.03], hypoxia [OR = 3.33, 95% CI (2.15~5.20), P = 0.003], electrolyte disorders [OR = 7.71, 95% CI (5.71~10.41), P = 0.09], and sleep disorders [OR = 5.50, 95% CI (3.49~9.63), P = 0.07] were risk factors for delirium after TURP. Conclusion: Existing evidence suggests that age, underlying diseases, postoperative bladder spasm, electrolyte disorders, hypoxia, and sleep disorders are the risk factors for the occurrence of delirium in patients after TURP. In clinical practice, medical personnel should pay attention to these risk factors, and need to strengthen the observation of postoperative TURP patients to achieve early assessment, early intervention, and early treatment, to reduce the impairment of patients’ cognitive function, and to improve the quality of life of the elderly, but limited by the quality of literature, the authenticity of the study results is not known. However, due to the limitation of the quality of the literature, the authenticity of the results of the study urgently needs to be further verified by more high-quality studies.