Efficacy and safety of Shenmai injection and Shenfu injection on postoperative cognitive dysfunction: a systematic review and meta-analysis
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common neurological complication after surgery, associated with increased adverse events and mortality. While studies suggest that Shenmai injection (SMI) or Shenfu injection (SFI) may be associated with reduce POCD, rigorous systematic reviews specifically on these two botanical drug injections are lacking.
Methods: We comprehensively searched eight databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, CBM) from inception to May 2025 for RCTs on SMI and SFI for POCD. Data were analyzed using RevMan 5.4. Primary outcomes were Mini-Mental State Examination (MMSE) score and POCD incidence. Secondary outcomes included serum S100β protein concentration and postoperative consciousness recovery time. Continuous outcomes used mean difference (MD) or standardized mean difference (SMD) with 95% CI; dichotomous outcomes used relative risk (RR) with 95% CI. This study was registered in INPLASY (registration number: 202470131).
Results: A total of 552 records were identified, and after deduplication and screening, sixteen RCTs (N = 1,199 patients) were finally included. Both SMI and SFI were associated with statistically significant higher postoperative MMSE scores at multiple time points (all P < 0.01) and were associated with lower POCD incidence at 3 days (SMI RR 0.38; SFI RR 0.52) and 7 days (SMI RR 0.26; SFI RR 0.47). However, all included trials were at high risk of bias (lack of allocation…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,199 participants or records.
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