利弗林与以弗得林的术内使用和术后狂妄症:一个多中心回顾性队列研究
Haobo Ma1, Elena Ahrens2, Luca J Wachtendorf2
1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Anesthesiology
|September 19, 2023
概括
与乙相比,在手术期间使用烯酸与术后妄想的风险更高有关. 需要进行进一步的临床试验,以确认是否能减少手术后妄.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 神经科学是一个神经科学.
背景情况:
- 在手术期间使用烯治疗低血压可能会因为血管收缩而损害大脑输液.
- 这种血管收缩与术后狂妄症的风险增加有关.
- 这项研究假设,与以弗得林相比,烯的使用增加了术后妄想的可能性.
研究的目的:
- 为了研究手术内用非尼利弗林与以弗得林与术后狂妄症的发生率之间的关联.
- 为了确定在全身麻醉期间使用烯是否与在手术后七天内发病妄想的可能性更高有关.
主要方法:
- 一项多中心医院注册研究包括103,094名成人患者,这些患者接受了非心脏,非神经外科手术的全身麻醉手术.
- 主要暴露是 fenilephrine 和 ephedrine 两种药物,首要结局是术后七天内 Delirium.
- 多变量逻辑回归分析调整了混变量,包括患者人口统计学,并发症,程序因素和手术内低血压大小.
主要成果:
- 76.6%的患者服用了烯,23%的患者服用了以弗得林. 手术后妄发生在0.8%的患者中,发生在7天内.
- 经过调整后的分析显示,烯与术后妄的更高几率有关 (aOR,1.35;95% CI,1.06至1.71).
- 观察到利弗林对痴呆风险的剂量依赖作用,较高的累积剂量与增加的几率相关.
结论:
- 与以弗得林相比,手术内给予烯与术后狂妄症的风险增加有关.
- 建议进行临床试验,以评估是否偏爱乙而不是烯可以减轻术后妄想.
- 这些发现表明麻醉管理策略的潜在修改,以改善患者的治疗结果.
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