基于雷米马佐拉姆的麻醉和系统性炎症生物标志物与老年患者的术后狂妄有关:一项回顾性队列研究
Hayoung Lee1, Keunyoung Kim2, Cheol Lee1
1Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk, Republic of Korea.
Medicina (Kaunas, Lithuania)
|June 27, 2025
概括
基于雷米马佐拉姆的静脉内全麻醉 (R-TIVA) 并没有降低术后妄想 (POD) 的发生率,但降低了炎症标志物. 在老年手术患者中,术前和术后的中性粒细胞与淋巴细胞比率 (NLR) 强烈预测了POD.
科学领域:
- 麻醉学 麻醉学
- 老年医学 老年医学
- 手术并发症 手术并发症
背景情况:
- 手术后痴呆症 (POD) 是接受重大手术的老年患者经常出现的并发症.
- 系统性炎症和麻醉技术可能会影响POD的发展.
- 研究新的麻醉方法,如基于雷米马佐拉姆的静脉内全麻醉 (R-TIVA),对于管理POD至关重要.
研究的目的:
- 为了比较R-TIVA与吸入麻醉 (IA) 和平衡麻醉 (BA) 在减少POD发病率和炎症生物标志物的疗效.
- 评估在接受重大非神经外科,非心脏手术的老年患者中系统性炎症生物标志物和POD之间的相关性.
主要方法:
- 对340名65岁或以上的患者进行了回顾性队列研究,分为R-TIVA,IA和BA组.
- 倾向分数匹配 (PSM) 为POD和无POD组创建了可比的队列.
- 测量系统性免疫炎症指数 (SII),中性粒细胞与淋巴细胞比率 (NLR),血小板与淋巴细胞比率 (PLR) 和C反应蛋白 (CRP) 在手术前和后.
主要成果:
- 在R-TIVA,IA和BA组之间没有观察到POD发病率的显著差异.
- 与IA相比,R-TIVA与术后SII,NLR,PLR和CRP水平显著降低有关.
- 术前和术后的NLR都显示出与POD有很强的相关性,并预测了其发生率.
结论:
- R-TIVA没有显著降低POD发病率,但有效降低了术后炎症生物标志物.
- 中性粒细胞与淋巴细胞的比率 (NLR) 是老年手术患者中POD的强有力的预测指标.
- 研究结果强调了麻醉在调节系统性炎症和POD风险方面的作用.
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