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

Abstract

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

CLC Number:

R 742
C 812

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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Insulin nasal drops for the prevention of delirium after surgery in elderly patients: a meta-analysis

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