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在短期脊髓麻醉和在共享决策后进行全身麻醉后的术后妄
Valesca Kipping1, Timo B Kerlin1, Friedrich Borchers1
1Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Germany.
在麻醉选择中共享决策显著降低了术后妄想的发生率. 与全身麻醉相比,选择脊髓麻醉的患者的妄想率较低,这凸显了患者偏好在手术结果中的重要性.
科学领域:
- 麻醉学 麻醉学
- 老年医学 老年医学
- 手术结果研究研究.
背景情况:
- 以前的随机对照试验 (RCT) 在麻醉技术之间没有发现术后妄想率的差异.
- 患者的焦虑和疼痛,通常在RCT中没有得到解决,与术后妄想有关.
- 共享决策 (SDM) 可以积极影响患者的焦虑和疼痛感知.
研究的目的:
- 评估SDM对术后妄想发病率的影响.
- 通过SDM选择时,将脊髓麻醉和全身麻醉之间的妄想率进行比较.
主要方法:
- 对192名患者进行了前性,观察性,双臂队列研究,这些患者接受了短时间 (<90分钟) 的下肢,腹部,骨盆或围手术.
- 利用三谈SDM模型进行麻醉选择 (脊椎与一般).
- 使用经过验证的手术前和手术后尺度测量患者的焦虑和疼痛.
主要成果:
- 在脊髓麻醉组中,术后妄想发生的频率明显较小 (2.1%) 与全身麻醉组相比 (16.8%;p < 0.001).
- 在通过SDM选择脊髓麻醉的患者中没有观察到妄想 (0%对16.8%;p <0.001).
- 两组麻醉者之间的焦虑和疼痛水平没有显著差异.
结论:
- SDM引导的脊髓麻醉与术后妄想的发生率低于全身麻醉.
- 将患者的偏好和观点纳入麻醉决策可能会改善外科手术结果.
- 进一步的研究应该考虑在研究麻醉技术和术后结果的试验中以患者为中心的方法.
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