术后疼痛管理对老年患者手术后痴呆症的影响:一个潜在的单中心随机对照试验
Yuhao Du1, Jiangbing Cao2, Chen Gao2
1Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, Anhui, China. yuhaodu2024@163.com.
这项研究发现,在接受膝关节手术的老年患者中,使用 nociceptive stimulus index (NOX) 来指导手术内止痛,可以减少手术后痴呆症 (POD) 的发生率. 与常规监测相比,NOX引导的管理改善了疼痛控制和降低了POD率.
科学领域:
- 麻醉学 麻醉学
- 老年医学 老年医学
- 外科手术的结果
背景情况:
- 手术后痴呆症 (POD) 是老年患者常见的并发症,与手术内镇静和止痛有关.
- 虽然双光谱指数 (BIS) 导向镇静可减少POD,但手术内止痛水平的作用尚不清楚.
- 这项研究研究了可感受性刺激指数 (NOX) 引导止痛对POD的影响.
研究的目的:
- 评估以 nociceptive刺激指数 (NOX) 为指导的手术内止痛管理对经过单边全膝关节整形手术 (TKA) 的老年患者手术后妄 (POD) 的影响.
主要方法:
- 一项前性,单中心随机受控研究,涉及接受单边TKA的老年患者 (≥65岁).
- 两个组进行了比较:使用BIS进行例行监测 (R组) 和NOX导向止痛,同时使用BIS监测镇静 (N组).
- 主要结局是3天内POD发生率,使用混评估方法 (CAM) 进行评估.
主要成果:
- 总共有240名患者被随机分配,其中228人被纳入分析.
- 与R组相比,N组在第一天的POD发病率明显较低 (7%对16%,P=0.041).
- 组N接受了显著更高的雷米芬坦尼尔剂量 (927.07±268.09毫克与882.32±187.91毫克相比,P=0.002).
结论:
- 由NOX指导的手术内止痛与手术后痴呆症 (POD) 的发生率降低有关.
- 在接受TKA的老年患者中,NOX引导的止痛药管理显著降低了POD,当镇静水平保持一致时.
- 这突显了优化手术内止痛药对手术患者妄预防的重要性.
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