胰岛素滴鼻对老年术后谵妄影响的meta分析

doi:10.3969/j.issn.1003-9198.2026.03.007

摘要/Abstract

摘要： 目的系统评价胰岛素滴鼻预防老年术后谵妄(POD)的有效性、安全性及最佳剂量。方法系统检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、Web of Science数据库,检索式为:主题词+自由词,英文:“Insulin, postoperative delirium, POD”;中文:“胰岛素、术后谵妄”,检索时间为各数据库建库至2025年6月。meta分析在RevMan 5.4软件中完成。结果共纳入8项随机对照试验(RCT)研究,共计901例老年病人,其中试验组(采用胰岛素滴鼻)527例,对照组(采用生理盐水滴鼻)374例。与对照组相比,试验组老年POD的发生率明显降低(RR=0.30,95％CI:0.23~0.40,P＜0.001),但20 U和40 U胰岛素滴鼻后POD的发生率差异无统计学意义(P＞0.05)。与对照组相比,试验组术后IL-6(SMD=-2.44,95％CI: -3.75~-1.12,P＜0.001)、CRP水平降低(SMD=-2.83,95％CI: -4.82～-1.28,P=0.005)。20 U胰岛素滴鼻病人与对照组病人不良反应发生率差异无统计学意义(P＞0.05),但有1项研究报道40 U胰岛素滴鼻病人较20、30 U胰岛素滴鼻病人及对照组病人的低血糖事件增加、血糖波动增大、鼻腔刺激评分升高(P<0.05)。结论使用20 U胰岛素滴鼻可降低老年POD的发生率,抑制术后IL-6、CRP水平升高,且不会增加不良反应。

关键词: 胰岛素滴鼻, 老年人, 术后谵妄, meta分析, 白细胞介素-6, C反应蛋白

Abstract: Objective To systematically evaluate the effectiveness, safety, and optimal dose of intranasal insulin in preventing postoperative delium (POD) in the elderly patients. Methods Systematic searches were conducted in the China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, China Biology Medicine disc (CBM), PubMed, Embase, Cochrane Library, and Web of Science databases using the search formula: Keywords+Free words, “Insulin, postoperative delirium, POD”, from the establishment of each database to June 2025. Meta-analysis was completed using RevMan 5.4 software. Results A total of 8 randomized controlled trials (RCT) involving 901 elderly participants were included, with 527 in the experimental group (receiving intranasal insulin) and 374 in the control group (receiving saline nasal drops). Compared with the control group, the incidence rate of POD was significantly lower in the experimental group (RR=0.30, 95%CI: 0.23－0.40, P＜0.001), but there was no statistically significant difference in the incidence rate of POD between the 20 U and 40 U intranasal insulin subgroups (P＞0.05). Compared with the control group, the experimental group had lower levels of postoperative IL-6 (SMD=-2.44, 95%CI: -3.75－-1.12, P＜0.001) and CRP (SMD=-2.83, 95% CI: -4.82－-1.28, P=0.005). There were no significant differences in the incidence rates of adverse reactions between 20 U intranasal insulin subgroup and control group, but one study reported that the 40 U intranasal insulin subgroup experienced increased hypoglycemic events, greater glycemic variability and higher nasal irritation score compared to 20, 30 U intranasal insulin subgroups or control group. Conclusions 20 U intranasal insulin can reduce the incidence of POD, inhibit the elevation of postoperative IL-6 and CRP levels, and does not increase the incidence of adverse reactions in the elderly patients.

Key words: intranasal insulin, aged, postoperative delirium, meta-analysis, interleukin-6, C-reactive protein

中图分类号:

R 742
C 812

肖玲怡, 肖国锦, 廖顺琪, 侯素颖, 刘李鑫, 夏琳. 胰岛素滴鼻对老年术后谵妄影响的meta分析[J]. 实用老年医学, 2026, 40(3): 254-260.

XIAO Lingyi, XIAO Guojin, LIAO Shunqi, HOU Suying, LIU Lixin, XIA Lin. Insulin nasal drops for the prevention of delirium after surgery in elderly patients: a meta-analysis[J]. Practical Geriatrics, 2026, 40(3): 254-260.

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