不同血压管理策略对老年髋关节置换术患者术后谵妄的影响：一项单中心随机对照试验。

Effects of different BP management strategies on postoperative delirium in elderly patients undergoing hip replacement: A single center randomized controlled trial.

作者信息

Xu XingMei, Hu XianWen, Wu Yun, Li Yun, Zhang Ye, Zhang MuChun, Yang QingQing

机构信息

Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei 230032, China; Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Anhui 230032, China.

出版信息

J Clin Anesth. 2020 Jun;62:109730. doi: 10.1016/j.jclinane.2020.109730. Epub 2020 Jan 24.

DOI:10.1016/j.jclinane.2020.109730

PMID:31982847

Abstract

STUDY OBJECTIVE

Postoperative delirium (POD) is a common after hip replacement. Intraoperative blood pressure management may affect postoperative delirium. The aim of this study was to compare the effects of different blood pressure management strategies on POD.

DESIGN

A single center randomized controlled trial.

SETTING

The Second Hospital of Anhui Medical University, Hefei, China.

PATIENTS

A total of 150 patients aged 65-80 years underwent hip arthroplasty.

INTERVENTIONS

A random number table was used to divide the patients into three groups: mean blood pressure (MAP) was maintained from 10% to 20% below the baseline (group D), MAP was maintained from baseline to 10% below the baseline (group M), and MAP was maintained from baseline to 10% above the baseline (group H).

MEASUREMENTS

The primary endpoint was POD at 1-3 days. The secondary endpoint was the intraoperative MAP and regional cerebral oxygen saturation (rSO) value, MAP, Visual Analogue Scale (VAS score) 1-3 days after surgery, the lengths of post anesthesia care unit (PACU) stay and hospital stay and emergence agitation were recorded.

MAIN RESULTS

Patients in group H showed a lower incidence of POD on the first day than those in groups D and M (22% and 16% vs 4%; P = 0.031). There is no difference of incidence of POD on the 2rd and 3rd day postoperatively. Patients in group H received a higher MAP as well as rSO during the operation compared the other two groups (P < 0.05). Compared with groups D and M, emergence agitation was significantly reduced (P = 0.029) and the lengths of PACU stay (P = 0.018) and hospital stay (P = 0.008) were shortened in group H.

CONCLUSIONS

Maintenance of intraoperative blood pressure from baseline to 10% above the baseline helps to reduce the incidence of POD and emergence agitation and shorten the lengths of PACU stay and hospital stay, and it may be related to increased rSO during the operation.

摘要

研究目的

术后谵妄（POD）是髋关节置换术后常见的并发症。术中血压管理可能会影响术后谵妄。本研究的目的是比较不同血压管理策略对POD的影响。

设计

单中心随机对照试验。

地点

中国合肥安徽医科大学第二附属医院。

患者

共有150例年龄在65 - 80岁的患者接受了髋关节置换术。

干预措施

使用随机数字表将患者分为三组：平均动脉压（MAP）维持在基线以下10%至20%（D组），MAP维持在基线至基线以下10%（M组），MAP维持在基线至基线以上10%（H组）。

测量指标

主要终点是术后1 - 3天的POD。次要终点是术中MAP和局部脑氧饱和度（rSO）值、术后1 - 3天的MAP、视觉模拟评分（VAS评分）、麻醉后监护病房（PACU）停留时间和住院时间以及苏醒期躁动情况均被记录。

主要结果

H组患者术后第一天POD的发生率低于D组和M组（分别为22%、16%和4%；P = 0.031）。术后第2天和第3天POD的发生率无差异。与其他两组相比，H组患者术中接受了更高的MAP以及rSO（P < 0.05）。与D组和M组相比，H组苏醒期躁动明显减少（P = 0.029），PACU停留时间（P = 0.018）和住院时间（P = 0.008）缩短。