与芬太尼相比,苏芬太尼在老年外科手术期间缺血性中风患者中增加了妄想风险:一项回顾性队列研究
Yanan He1,2, Mengyao Qu1,2, Yuxiang Song1,2
1Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Frontiers in medicine
|March 2, 2026
概括
在外科手术期间使用的芬太尼显著降低了经过外科手术期间缺血性中风 (PIS) 的老年患者手术后 Delirium (POD) 的风险. 这一发现强调了阿片类药物选择是管理这一高风险患者群体的关键因素.
科学领域:
- 麻醉学 麻醉学
- 神经学 神经学
- 关键护理医学 关键护理医学
背景情况:
- 术后缺血性中风 (PIS) 和术后妄 (POD) 是严重的中枢神经系统并发症.
- 它们的联合发生尚未得到充分研究,对风险因素的证据有限.
- 这项研究调查了PIS和POD结合的发病率,预后和阿片类药物相关的风险因素.
研究的目的:
- 检查老年患者中由POD复杂的PIS的发病率和预后.
- 评估手术期间选择的阿片类药物 (芬太尼与苏芬太尼) 对PIS和POD联合风险的影响.
- 为了确定这种双重并发症的潜在可修改的风险因素.
主要方法:
- 对376,933名非心脏手术患者 (2008-2019) 的回顾性分析.
- 鉴定了178名患有PIS的老年患者 (≥65岁),比较了芬太尼 (n=73) 和苏芬太尼 (n=105) 组.
- 使用Kaplan-Meier生存分析,后勤回归和倾向性得分匹配来评估POD风险和结果.
主要成果:
- 老年PIS患者的整体POD发病率为40.4%.
- POD与明显更差的生存率 (30%与50%相比) 有关.
- 与sufentanil相比, fentanyl的使用与明显较低的POD发病率 (6.8%与63.8%) 和降低的风险 (OR:0.017,p < 0.001) 有关.
结论:
- 与sufentanil相比,手术内使用芬太尼在患有PIS的老年患者中显著降低POD风险.
- 阿片类药物选择是改善这一高风险人群的结果的潜在可修改的风险因素.
- 研究结果表明,通过选择阿片类药物优化麻醉管理可以增强患者的康复.
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