大腸がん患者における術後の妄想の予防のためのケタミンとメラトニン:可行性研究
Kousha Farhadi1, Mojgan Rahimi2, Hesam Varpaei3
1Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. koushafarhadi@gmail.com.
Perioperative medicine (London, England)
|August 22, 2025
まとめ
術前のメラトニンと手術中のケタミンは,大腸外科手術患者の術後の妄想症 (POD) を有意に予防しなかった. しかし,この研究は,患者募集率と患者留保率を許容できる手術前介入試験の可行性を確認した.
科学分野:
- 麻酔学と手術前医学
- 手術腫瘍学
- 薬理学について
背景:
- 術後の妄想 (POD) は,大手術後の一般的な合併症であり,特に大腸がん手術を受けた高齢者の場合です.
- PODの現在の予防戦略は限られており,新しい手術前介入に関する研究が必要である.
研究 の 目的:
- 大腸がん手術患者のPOD予防のための手術前のメラトニンと手術中のケタミンを評価する複数の腕の研究の可行性を評価する.
- PODと痛みの発生率と重症度を減らすためのこれらの介入の有効性を決定する.
主な方法:
- 選択性大腸がん手術を受けた成人の患者を対象としたランダム化比較試験です.
- 4つのグループ:プラセボ/塩分溶液,メラトニン/塩分溶液,プラセボ/ケタミン,そしてメラトニン/ケタミン,手術前および手術中の介入.
- PODの評価は,集中治療室 (CAM- ICU) の混乱評価方法と,視覚アナログスケール (VAS) を用いて,術後4日目まで評価する.
主要な成果:
- この研究では,成功率13. 3%の104人の患者が採用され,実現可能性が示されました.
- PODの罹患率はすべてのグループで似ていた (16. 67%から22. 23%),プラセボと比較して,どの介入群でも有意な減少は見られなかった.
- 介入はPODを減少させなかったが,時間とともにPODの発生率,重症度,および痛みの縦断的な減少が認められた.
結論:
- 術後の介入試験の設計は実行可能で,大腸がん手術の患者募集率と患者留守率は受け入れられた.
- この患者群では,手術前のメラトニンも,手術中のケタミンも,手術後の妄想の発生率を有意に低下させなかった.
- 追加の研究は,POD予防戦略を最適化するために,代替用量,組み合わせ,または患者集団を探索することができます.
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