28-老年髋部手术术后谵妄发病率的Meta分析二院庞清江.docVIP

老年髋部手术术后谵妄发病率的Meta分析 邬耀军* 庞清江 刘江涛 胡月明 *单位：宁波市第二医院骨科中心 通讯作者：庞清江，E-mail：pqjey@ 摘要： 目的：运用Meta分析综合评价老年髋部手术术后谵妄的发病率。 方法：通过检索Pubmed数据库及对相关文献的引文追溯，收集从2004年1月1日至2013年12月31日公开发表的国内外有关老年髋部手术术后谵妄发病率的临床研究。制定文献的纳入及排除标准，严格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为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[OR=0.32， 95%CI （0.22,0.45）]，明显降低。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。 关键词：老年，髋部手术，术后谵妄，发病率，Meta分析 The incidence of postoperative delirium associated with hip surgery in elderly patients：a meta-analytic review WU Yao-jun*， PANG Qing-jiang， LIU Jiang-tao， CAO shuai， HU Yue-ming * Department of Orthopedics Surgery, Ningbo No.2 Hospital, Zhejiang, 315010 Corresponding Author： PANG Qing-jiang, Email:pqjey@ Abstract： Objective： The aim of this study was to perform a meta-analysis of the literature regarding the incidence of delirium following hip surgery in elderly patients. Method: The related literatures published between 2004 and 2013 were collected from Pubmed. Literatures were selected in strict accordance with the inclusion and exclusion criteria. The information of literatures was extracted by excerpts questionnaire, and recorded by two independent researchers. I2 was calculated to test heterogeneity among study. A random effects model was used if I2＞50%. Subgroup analysis was done according to age, delirium rating scale and region. Publication bias was done by the Begg method. The Stata 12.0 software was used for statistical analysis. Results: 21 studies met our inclusion criteria for review. The combined results showed that the incidence of postoperative delirium was 17% [95CI%, (16%, 18%)]. The incidence of deliri