麻醉并发症：术后谵妄 与OSAS

本文由“小麻哥的日常"授权转载

摘要译文（供参考）

阻塞性睡眠呼吸暂停老年患者术后谵妄的预防：一项随机对照试验

背景：

阻塞性睡眠呼吸暂停（OSA）与神经认知障碍相关，神经认知障碍是术后谵妄的已知危险因素。然而，尚不清楚OSA是否会增加术后谵妄的风险，治疗是否具有保护作用。

目的：

本研究的目的是通过家庭睡眠呼吸暂停试验（HSAT）确定阻塞性睡眠呼吸暂停综合征（OSA），并确定自动滴定气道正压通气（APAP）是否能降低接受选择性髋关节或膝关节置换术的新诊断OSA的老年患者术后谵妄。

方法：

我们在加拿大三家学术医院进行了多中心随机对照试验。

研究伦理委员会从参与地点获得批准，并从参与者处获得知情同意。

纳入标准为[详见正文]新诊断OSA的患者，计划进行择期髋关节或膝关节置换。

STOP Bang评分≥ 3人的患者行HSAT。

呼吸暂停低通气指数≥ 10/小时被诊断为OSA。

这些患者按1:1的比例随机分为：

1）术后72小时或至出院前行APAP治疗，或2）术后常规护理。

主要结果是术后谵妄，采用谵妄评估量表(CAM）每天评估两次，持续72小时或直到出院，或通过图表回顾。

次要结局指标包括住院时间和术后30天内发生的围手术期并发症。

结果：

在549名入组患者中，474名患者完成了HSAT。

共有234名新诊断的阻塞性睡眠呼吸暂停综合征患者被随机分组。

平均年龄为68.2（6.2）岁，58.6%为男性。

对220名患者进行了分析。

总计，2.7%（6/220）患者术后出现谵妄：常规护理组为4.4%（5/114）患者，治疗组为0.9%（1/106）患者（P=0.21）。

APAP组与常规护理组的平均住院时间分别为2.9（2.9）天和3.5（4.5）天（P=0.24）。

术后第1晚，使用APAP 超过4小时/夜的患者占53.5%，第2晚下降到43.5%，第3晚下降到24.6%。

两组术中和术后并发症没有差异。

结论：

我们的术后谵妄发生率出乎意料地低，因此我们无法确定在择期膝关节或髋关节置换术老年患者中接受APAP治疗的新诊断OSA患者与未接受APAP治疗的患者相比，术后谵妄是否减少。

试验注册：

该试验在临床试验中进行了回顾性注册。注册号：gov NCT02954224 on 03/11/2016。

关键词：

谵妄；老年人家庭睡眠呼吸暂停测试；阻塞性睡眠呼吸暂停；老年人；气道正压；术后。

The prevention of delirium in elderly surgical patients with obstructive sleep apnea (PODESA): a randomized controlled trial

Background: Obstructive sleep apnea (OSA) is associated with neurocognitive impairment - a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty.

Methods: We conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were [Formula: see text]0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea-hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery.

Results: Of 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups.

Conclusions: We had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty.

Trial registration: This trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016.

Keywords: Delirium; Elderly; Home sleep apnea tests; Obstructive sleep apnea; Older adults; Positive airway pressure; Postoperative.

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编辑：Michel.米萱

校对：Mijohn.米江

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