术前口服盐水对老年人术后谵妄的影响：一项随机对照试验

贵州医科大学麻醉与心脏电生理课题组

翻译 : 宋雨婷 

编辑 : 严旭  

审校 : 曹莹

目的：术后谵妄（POD）严重影响老年人的身体恢复，增加其术后死亡率。本研究旨在评估术前口服盐水对接受椎管减压的老年人术后谵妄的影响。

设计：该项随机对照试验于一大型三甲医院进行。

设置和参与者：2020年5月至2021年1月期间，共纳入76名拟行脊柱手术的老年患者（≥65岁）。

方法：将拟行择期椎管减压术的老年人（65-83岁）随机分为对照组（n = 38）或干预组（n = 38）。对照组术前8 h禁饮，干预组在麻醉前2小时给予5 mL·kg−1生理盐水。在基线和术后不同时间点记录血流动力学指标、诊断标志物、术前简易精神状态评分和术中液体动力学指标。之后对受试者进行POD和术后疼痛评分。

结果：干预组中，S 100β蛋白在麻醉苏醒后30分钟（S1）（FS1= 12.289，P <0.001） 和术后24小时（S2）（FS2= 12.440，P <0.001）中降低，而平均动脉血压（FT1= 42.997，P <0.001）和心率（FT1= 8.974，P =0.004）增加。干预组中，Ln c-反应蛋白术后1天降低（FS2= 6.305，P = 0.014）。对照组术后谵妄发生率高于干预组（27.8% 比8.3%，χ2= 4.547，P = 0.033）。

结论：术前口服生理盐水可通过最大限度地减少围手术期血流动力学波动和中枢神经系统损伤来降低老年人术后谵妄的发生率。

原始文献来源 ： 

Chen J, Xie S, Chen Y, Qiu T, Lin J. Effect of Preoperative Oral Saline Administration on Postoperative Delirium in Older Persons: A Randomized Controlled Trial. Clin Interv Aging. 2022;17:1539-1548.

英文原文

Effect of Preoperative Oral Saline Administration on Postoperative Delirium in Older Persons: A Randomized Controlled Trial

Abstract

Objective: Postoperative delirium (POD) seriously affects recovery of older persons, increasing their mortality rate after surgery. We aimed to evaluate preoperative oral saline administration on postoperative delirium in older persons undergoing spinal decompression.

Design: A randomised controlled trial in a large tertiary hospital.

Setting and Participants: A total of 76 older persons (≧65 years old) undergoing spinal surgery from May 2020 to January 2021.

Methods: Older persons (65–83 years old) who underwent elective spinal canal decompression were randomly grouped into either the control group (n = 38) or the intervention group (n = 38). The control group was forbidden from drinking 8 hours prior to the operation while the intervention group was administered 5 mL·kg−1 of normal saline 2 hours before anesthesia. Hemodynamic indicators, diagnostic biomarkers, preoperative mini-mental status scores, and intraoperative fluid dynamics were recorded at baseline and at various postoperative timepoints. Subjects were then scored for POD and postoperative pain.

Results: S100β protein was lowered in S1 (FS1 = 12.289, P <0.001) and S2 (FS2 = 12.440, P <0.001) in the intervention group while mean arterial blood pressure (FT1= 42.997, P<0.001) and heart rate (FT1= 8.974, P=0.004) were increased. The Ln c-reactive protein of the intervention group was lowered 1 day postoperatively (FS2 = 6.305, P = 0.014). The incidence of postoperative delirium in the control group was higher than in the intervention group (27.8% vs 8.3%, χ2 = 4.547, P = 0.033).

Conclusion: Preoperative oral saline can reduce the incidence of postoperative delirium in older persons by minimizing perioperative hemodynamic fluctuations and central nervous system damage.

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来源 | 健康界

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