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机器人辅助与开放性耻骨后根治性前列腺切除术后麻醉恢复室谵妄:一项前瞻性观察研究。

Postanesthesia care unit delirium following robot-assisted vs open retropubic radical prostatectomy: A prospective observational study.

作者信息

Beck Stefanie, Hoop Dennis, Ragab Haissam, Rademacher Cornelius, Meßner-Schmitt Aurelie, von Breunig Franziska, Haese Alexander, Graefen Markus, Zöllner Christian, Fischer Marlene

机构信息

Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Int J Med Robot. 2020 Jun;16(3):e2094. doi: 10.1002/rcs.2094. Epub 2020 Mar 5.

Abstract

BACKGROUND

The aim of this study was to compare the incidence of early postoperative delirium in the postanesthesia care unit (PACU) between robot-assisted radical prostatectomy (RARP) in the extreme Trendelenburg position and open retropubic radical prostatectomy (ORP) in supine position.

METHODS

Patients were screened for delirium signs 15, 30, 45, and 60 minutes following extubation.

RESULTS

PACU delirium was present in 39.3% of RARP (64/163) patients and 41.8% of ORP (77/184) patients. Higher age (OR 1.072, 95%CI: 1.034-1.111, P < .001), total intravenous anesthesia (OR 2.001, 95%CI: 1.243-3.221, P = .004), and anesthesia duration (OR 1.255, 95%CI: 1.067-1.476, P = .006) were associated with PACU delirium, but no association was found between surgical technique and PACU delirium.

CONCLUSION

Compared with inhalational anesthesia, total intravenous anesthesia using propofol-sufentanil, higher age, and longer duration of anesthesia were associated with PACU delirium. Based on these findings, adverse effects on postoperative recovery and delirium signs do not have to be considered in the choice of surgical approach for radical prostatectomy.

TRIAL REGISTRATION

https://www.drks.de/, identifier: DRKS00010014.

摘要

背景

本研究旨在比较极度头低脚高位机器人辅助根治性前列腺切除术(RARP)与仰卧位耻骨后根治性前列腺切除术(ORP)术后早期谵妄在麻醉后恢复室(PACU)中的发生率。

方法

在拔管后15、30、45和60分钟对患者进行谵妄体征筛查。

结果

RARP组(64/163)患者中39.3%出现PACU谵妄,ORP组(77/184)患者中41.8%出现PACU谵妄。年龄较大(OR 1.072,95%CI:1.034-1.111,P<0.001)、全静脉麻醉(OR 2.001,95%CI:1.243-3.221,P = 0.004)和麻醉持续时间(OR 1.255,95%CI:1.067-1.476,P = 0.006)与PACU谵妄相关,但未发现手术技术与PACU谵妄之间存在关联。

结论

与吸入麻醉相比,使用丙泊酚-舒芬太尼的全静脉麻醉、年龄较大和麻醉持续时间较长与PACU谵妄相关。基于这些发现,在选择根治性前列腺切除术的手术方式时,不必考虑对术后恢复和谵妄体征的不良影响。

试验注册

https://www.drks.de/,标识符:DRKS00010014。

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