Postoperative delirium (POD) is a serious postoperative complication, which is significantly correlated with poor prognosis such as prolonged hospital stay and increased rate of readmission. POD is the result of multiple factors, and intervention targeting at its risk factors can significantly reduce the incidence of POD. At present, POD prevention tends to be multidisciplinary and cluster-oriented, aiming at forming a process-oriented, whole-perioperative assessment and intervention path. However, at present, there are few studies on POD peri-anesthetic period intervention, and there are many controversies. All guidelines and expert consensus are also blank in this part, and further studies are needed to fill the gaps. This paper discusses the current prevention strategies for POD during peri-anesthetic period, guiding future studies and further improving the intervention strategies for POD during peri- anesthetic period, so as to reduce the occurrence of POD.
ObjectiveTo systematic review the efficacy and safety of acupuncture on patients with sepsis.MethodsThe PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were searched. The retrieval time was from the inception to October 1st, 2019. The randomized controlled trials (RCTs) about acupuncture on the sepsis were screened. Two researchers independently screened the articles, extracted and analyzed the data, evaluated the risk of bias included in the study. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 20 RCTs involving 1 337 patients were included. Meta-analysis showed that there were significant differences between the acupuncture group with conventional treatment in 28-day mortality [RR=0.69, 95%CI (0.5, 0.9), P=0.03], APACHE II score at 3rd day [MD=−2.4, 95%CI (−3.68, −1.12), P=0.0002] and 7th day [MD=−4.37, 95%CI (−6.32, −2.21), P<0.0001], length of the ICU stay [MD=−1.54, 95%CI (−2.81, −0.27), P=0.02], the effective rate for improved gastrointestinal function [RR=1.5, 95%CI (1.09, 2.06), P=0.01], concentrations of PCT [MD=−2.23, 95%CI (−3.33, −1.13), P<0.001] and TNF-α [MD=-14.86, 95%CI (−23.74, −5.97), P=0.001] at 7th day. However, there was no significant difference between the two groups about the CD8+ count at 7th day [MD=1.65, 95%CI (−0.32, 3.62), P=0.1].ConclusionAvailable evidence suggests that acupuncture may be a potential treatment method for sepsis patients. Due to the limited quantity and quality of included studios, the above conclusions are needed to be verified by more high-quality studies.