在逆向全肩关节整形术后的术后妄想:间层阻塞与全身麻醉对比
Sung Min Rhee1, Soo Young Kim2, Cheol Hwan Kim2
1Shoulder and Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Korea.
Clinics in orthopedic surgery
|April 2, 2025
概括
对于接受逆向全肩关节整形手术 (rTSA) 的老年患者,跨块 (IB) 麻醉是一种比全息麻醉 (GA) 更好的选择. 与GA相比,IB可以减少术后妄 (PD) 和疼痛.
科学领域:
- 整形外科手术 整形外科手术
- 麻醉学 麻醉学
- 老年医学 老年医学
背景情况:
- 手术后痴呆症 (PD) 在接受重大骨科手术的老年患者中是一个重大问题.
- 对于不可弥补的大规模旋转手套撕裂 (mRCTs) 的逆向全肩关节整形手术 (rTSA) 在老年人群中越来越普遍.
- 麻醉技术可能会影响PD的发生率和严重程度.
研究的目的:
- 为了比较手术后妄想症 (PD) 的严重程度,在接受mRCT的老年患者中进行rTSA.
- 为了评估全身麻醉 (GA) 与间层阻断 (IB) 对PD的影响.
- 评估与每个麻醉技术相关的术后疼痛水平.
主要方法:
- 一项前性病例对照研究,涉及40名老年患者 (≥65岁),接受mRCT的rTSA治疗.
- 患者被分为两组:20组接受GA治疗,20组接受IB治疗.
- 在多个手术后的时间点上,使用 Delirium Rating Scale-revised-98 (DRS) 评估 Delirium 严重程度.
主要成果:
- 与全身麻醉 (GA) 组相比,在手术后立即发生的疼痛明显减少 (VAS差异:3.80与6.25).
- 虽然在最初几天没有统计学意义,但IB组 (1.30) 与GA组 (4.15) (p=0.014) 的DRS得分的平均变化明显低于基线.
- GA组在术后第3天显示了DRS得分的峰值,而IB组的峰值发生在术后第0天.
结论:
- 间层阻塞 (IB) 是一种有效的麻醉选择,用于减少接受rTSA的老年患者的术后妄想.
- 与全身麻醉 (GA) 相比,IB麻醉与较低的妄想严重程度和减少的术后疼痛有关.
- 麻醉选择在经过肩关节整形手术的老年患者的术后结果管理中起着至关重要的作用.
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