| 摘要 |
[Objectives] To evaluate the impact of nasal insulin administration on postoperative delirium (POD) through meta-analysis. [Methods] The Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (CSTJ) were systematically searched for relevant literature published prior to February 27, 2025. Literature screening and data extraction were conducted by two independent researchers in accordance with predetermined inclusion and exclusion criteria. The primary observation indicator was the incidence of POD across various treatment populations. The risk ratio for the primary outcome was calculated using the Mantel-Haenszel method. The secondary outcomes included the adverse effects associated with insulin treatment, which encompassed the glycemic variability indices, the incidence of nasal irritation symptoms following administration, hypoglycemic reactions, and insulin allergic reactions. The study protocol was registered on PROSPERO (CRD420250607492) before data extraction. [Results] A total of five randomized controlled trials involving 357 patients were included in the analysis. In the adult population undergoing surgical procedures, the administration of insulin via nasal delivery was found to significantly reduce the incidence of POD [RR=0.35, 95% CI (0.23-0.53), P<0.001]. The results of the subgroup analysis indicated that there were notable differences in the effectiveness of various doses of insulin administered nasally in preventing POD. Specifically, both the 20 U dose group [RR=0.45, 95% CI：(0.29, 0.70), P<0.001] and the 30 U dose group [RR=0.01, 95% CI：(0.03, 0.42), P<0.001] showed a significantly lower incidence of POD compared to the control group, with statistically significant conclusions. Conversely, the 40 U dose group [RR=0.47, 95% CI：(0.17, 1.34), P=0.16] yielded no statistically significant difference. Furthermore, the efficacy in preventing POD was found to be greater in the 30 U dose group compared to the 20 U dose group. Additionally, two cases of hypoglycemic reactions and increased nasal irritation symptom scores were reported in the 40 U dose group across the entire study population (P<0.05), suggesting potential adverse risks associated with this dosage. [Conclusions] The nasal administration of insulin significantly decreases the incidence of POD at a specific dosage, with optimal efficacy and high safety observed at a dosage of 30 U. |
