在老年人骨科手术中,沙椅定位后的术后认知功能障碍与卧卧姿相比
Philipp Groene1, Tanja Schaller2, Catharina Zeuzem-Lampert2
1Department of Anaesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. philipp.groene@med.uni-muenchen.de.
Archives of orthopaedic and trauma surgery
|October 27, 2023
概括
在沙椅姿势下接受肩部手术的老年患者在手术后一周,与卧卧姿势相比,出现了更多的术后认知功能障碍 (POCD) 的趋势. 这种差异在统计学上并不显著.
科学领域:
- 麻醉学 麻醉学
- 神经外科 神经外科
- 老年医学 老年医学
背景情况:
- 术后认知功能障碍 (POCD) 影响高达26%的老年患者在非心脏手术一周内.
- 沙椅定位 (BCP) 在肩膀手术中很常见,但由于血液体积再分配,可能会导致大脑缺血.
- 该研究调查了BCP增加POCD风险的假设在60岁以上的患者接受骨科肩部手术与卧卧姿势 (SP) 相比.
研究的目的:
- 为了比较POCD的发病率在老年患者接受骨科肩部手术在沙椅位置与卧底位置.
- 评估手术内定位对手术后短期认知功能的影响.
主要方法:
- 进行了一项前性观察性试验,涉及114名骨科患者.
- 根据手术期间的位置分组患者:沙椅位置 (BCP) 或仰卧位置 (SP).
- 在手术后一周评估POCD,使用Trail Making Test,字母数字跨度和Regensburger Word流利性测试.
主要成果:
- 一周后的POCD发病率在BCP组为21.1%,在SP组为10.5% (p=0.123).
- 在两组中,POCD的发病率在手术后4周下降 (SP:8.8%与BCP:5.3%).
- 近红外光谱 (NIRS) 值在POCD和没有POCD的患者之间没有显著差异.
结论:
- 在手术后一周,在沙椅姿势相比,在卧卧姿势下进行手术的患者中观察到较高POCD发病率的趋势.
- 这一趋势没有达到统计学意义,这表明定位可能不是一个主要的独立风险因素的POCD在这种情况下.
- 可能需要进一步的研究来澄清BCP和POCD之间的关系.
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