ペネヒクリジン塩酸塩の前投薬は、手術後の認知機能障害やせん妄の発生率の増加とは関連していません：A Systemic Review and Meta-Analysis（全身レビューとメタアナリシス）

Penehyclidine Hydrochloride Premedication Is Not Associated with Increased Incidence of Post-Operative Cognitive Dysfunction or Delirium:A Systemic Review and Meta-Analysis.

• Yun Tai Yao
• Hua Ying
• Neng Xin Fang
• Yong Bao Zhang
• Xin Yuan

抄録

目的 術後認知機能障害（POCD）と術後せん妄（POD）は、術後の脳合併症の一つである。方法 PHC とアトロピン/スコポラミン/プラセボとを比較した無作為化比較試験をすべて電子データベースで検索し、手術患者の POCD と POD に対する PHC の効果を系統的に検討した。主要評価項目はPOCDとPODの発生率であり、副次評価項目は術前ミニ精神状態検査（MMSE）のスコアであった。2人の著者が独立して、患者のベースライン特性、手術変数、転帰データを含む術中データを抽出した。二項データ（POCDとPODの発生）については、治療効果をオッズ比（）と95％秘密区間（）として計算した。各アウトカムについて異質性を検定し、有意な異質性の有無にかかわらず、ランダム化効果または固定効果モデルを使用した。連続変数（MMSEスコア）については、治療効果を加重平均差（WMD）と95% .結果 検索の結果、4017人の患者を含む33の研究が得られた。メタ解析の結果、PHC群のPOCD発症率は、生理食塩水群(=0.97; 95% : 0.58-1.64; =0.92)、スコポラミン群(=0.78; 95% : 0.48-1.27; =0.32)、アトロピン群(=1.20; 95% : 0.86-1.67; =0.29)に匹敵することが示された。PHC群のPOD発症率は生理食塩水群(=1.53; 95% : 0.81-2.90; =0.19)、スコポラミン群(=0.53; 95% : 0.06-4.56; =0.56)と同等であったが、アトロピン群(=4.49; 95% : 1.34-15.01; =0.01)よりも高かった。

Objective Post-operative cognitive dysfunction (POCD) and post-operative delirium (POD) are two common post-operative cerebral complications. The current meta-analysis was to systematically review the effects of penehyclidine hydrochloride (PHC) on POCD and POD in surgical patients.Methods Electronic databases were searched to identify all randomized controlled trials comparing PHC with atropine/scopolamine/placebo on POCD and POD in surgical patients. Primary outcomes of interest included the incidences of POCD and POD; the secondary outcomes of interest included peri-operative mini-mental state examination (MMSE) scores. Two authors independently extracted peri-operative data, including patients' baseline characteristics, surgical variables, and outcome data. For dichotomous data (POCD and POD occurrence), treatment effects were calculated as odds ratio () and 95% confidential interval (). Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity. For continuous variables (MMSE scores), treatment effects were calculated as weighted mean difference (WMD) and 95% . Statistical significance was defined as <0.05.Results Our search yielded 33 studies including 4017 patients. Meta-analysis showed that, the incidence of POCD in PHC group was comparable to that in saline group (=0.97; 95% : 0.58-1.64; =0.92), scopolamine group (=0.78; 95% : 0.48-1.27; =0.32) and atropine group (=1.20; 95% : 0.86-1.67; =0.29). The incidence of POD in PHC group was comparable to that in saline group (=1.53; 95% : 0.81-2.90; =0.19) and scopolamine group (=0.53; 95% : 0.06-4.56; =0.56), but higher than that in atropine group (=4.49; 95% : 1.34-15.01; =0.01).Conclusions PHC premedication was not associated with increased incidences of POCD or POD as compared to either scopolamine or placebo.