丙泊酚和七氟烷对老年患者术后谵妄的影响：随机临床试验研究

翻译：何幼芹  编辑：冯玉蓉  审校：曹莹

背景：术后谵妄与患者不良的术后结局相关。然而，静脉麻醉剂和吸入麻醉剂是否与术后谵妄的不同风险相关目前尚无研究报道。

目的：旨在探索静脉麻醉剂丙泊酚和吸入麻醉剂七氟烷对老年患者术后谵妄的发生率和持续时间的影响。

方法：将行全髋/膝关节置换术的老年患者随机分为丙泊酚麻醉组(N = 106)和七氟烷麻醉组(N = 103)。由对麻醉方案不知情的调查人员使用意识模糊评估法评估术后第1、2、3天术后谵妄的发生率和持续时间(每人术后谵妄天数)。

结果：共209例老年患者(年龄71.2±6.7岁，男性29.2%)进入最终数据分析。丙泊酚麻醉组和七氟烷麻醉组术后谵妄的发生率分别为33.0%和23.3%(P = 0.119，卡方检验)，我们估计每组需要316名受试者才能检测到潜在的统计学差异。丙泊酚麻醉组术后谵妄天数(0.5 ± 0.8)明显长于七氟烷麻醉组(0.3±0.5，P = 0.049，t检验)。

结论：这项初步研究建立了一个系统来比较不同麻醉剂的效果，并提出了一个假设，即使用丙泊酚麻醉的老年患者术后谵妄发生率和持续时间均比七氟烷高。然而，需要更大样本量的补充研究来验证这一假设。

原始文献来源：Mei X, Zheng HL, Li C, et al. The Effects of Propofol and Sevoflurane on Postoperative Delirium in Older Patients: A Randomized Clinical Trial Study[J] .J.Alzheimers Dis., 2020, 76: 1627-1636.

The Effects of Propofol and Sevoflurane on Postoperative Delirium in Older Patients: A Randomized Clinical Trial Study

[Abstract]

Background: Postoperative delirium is associated with adverse postoperative outcomes. However, whether intravenous and inhalation anesthetics are associated with different risks of postoperative delirium remains unknown.

Objective: We set up to determine the incidence and duration of postoperative delirium in older patients who had surgery under the intravenous anesthetic propofol or the inhalational anesthetic sevoflurane.

Methods: Participants were patients who had total hip/knee replacements and were randomized to propofol (N = 106) or sevoflurane (N = 103) anesthesia group. The Confusion Assessment Method was employed by investigators who were blinded to the anesthesia regimen to assess the incidence and duration (days of postoperative delirium per person) of postoperative delirium on postoperative days 1, 2, and 3.

Results: A total of 209 participants (71.2 ± 6.7 years old, 29.2% male) were included in the final data analysis. The incidence of postoperative delirium was 33.0% with propofol anesthesia and 23.3% with sevoflurane anesthesia (p = 0.119, Chi-square test), and we estimated that we would need 316 participants in each arm to detect a potential statistically significant difference. Days of postoperative delirium per person were higher in the propofol (0.5 ± 0.8) anesthesia group compared to the sevoflurane anesthesia group (0.3 ± 0.5, p = 0.049, Student’s t-test).

Conclusion: This pilot study established a system to compare effects of different anesthetics and generated a hypothesis that propofol trended to have a higher incidence and had longer duration of postoperative delirium than sevoflurane. Additional studies with a larger sample size are needed to test this hypothesis.