Williams-Russo P, Urquhart B L, Sharrock N E, Charlson M E
Department of Medicine, Hospital for Special Surgery, Cornell Arthritis and Musculoskeletal Diseases Center, Cornell University Medical College, New York, New York.
J Am Geriatr Soc. 1992 Aug;40(8):759-67. doi: 10.1111/j.1532-5415.1992.tb01846.x.
To compare the effect of post-operative analgesia using epidural versus intravenous infusions on the incidence of delirium after bilateral knee replacement surgery in elderly patients. Additional risk factors and impact on post-operative recovery were also assessed.
Prospective randomized controlled trial.
Urban referral hospital specializing in elective orthopedic surgery.
60 consecutive patients undergoing bilateral knee replacement surgery with epidural anesthesia were approached; 51 patients were eligible and consented. The mean age was 68, 55% were women, and there was a high prevalence of comorbid medical disease. No patient was demented pre-operatively.
Random allocation to either continuous epidural infusion of bupivacaine and fentanyl or continuous intravenous infusion of fentanyl. Infusions were initiated at the first complaint of pain and continued through the 36- to 48-hour stay in the recovery room.
Acute post-operative delirium defined using an algorithm based on DSM III criteria.
The overall incidence of acute delirium was 41%, with no difference between types of post-operative analgesia. Predictors of delirium were age, gender, and pre-operative alcohol use. All cases resolved within 1 week, and length of stay and achievement of physical therapy goals were the same for delirious and non-delirious patients.
There is a high incidence of post-operative delirium in elderly non-demented patients following bilateral knee replacement, regardless of whether post-operative analgesia is administered by the epidural or intravenous route.
比较老年患者双侧膝关节置换术后采用硬膜外与静脉输注进行术后镇痛对谵妄发生率的影响。还评估了其他危险因素及其对术后恢复的影响。
前瞻性随机对照试验。
一家专门从事择期骨科手术的城市转诊医院。
对60例连续接受硬膜外麻醉下行双侧膝关节置换手术的患者进行了研究；51例患者符合条件并同意参与。平均年龄为68岁，55%为女性，合并内科疾病的患病率较高。术前无患者患有痴呆症。
随机分配至连续硬膜外输注布比卡因和芬太尼或连续静脉输注芬太尼。在患者首次主诉疼痛时开始输注，并在恢复室停留的36至48小时内持续进行。
使用基于《精神疾病诊断与统计手册》第三版标准的算法定义的急性术后谵妄。
急性谵妄的总体发生率为41%，术后镇痛方式之间无差异。谵妄的预测因素为年龄、性别和术前饮酒情况。所有病例均在1周内缓解，谵妄患者与非谵妄患者的住院时间和物理治疗目标的达成情况相同。
老年非痴呆患者双侧膝关节置换术后谵妄的发生率较高，无论术后镇痛是通过硬膜外还是静脉途径给药。
