俯卧位时头部方向对老年胸腰椎手术患者术后谵妄的影响：一项随机对照试验的研究方案

Effects of head direction during prone position on postoperative delirium in elderly patients undergoing thoracolumbar spine surgery: a study protocol for a randomised controlled trial.

作者信息

Zhu Jixiang, Chen Yongzhuang, Chen Yangyang, Ma Hong, Liu Fengyun, Chen Qian, Wang Fang, Chen Xuetai, Xue Zhouya, Ni Kun, Li Feng, Qian Bin

机构信息

The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China.

Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory For Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical College, Xuzhou, Jiangsu, China.

出版信息

BMJ Open. 2024 Dec 31;14(12):e083526. doi: 10.1136/bmjopen-2023-083526.

DOI:10.1136/bmjopen-2023-083526

PMID:39740950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11749493/

Abstract

INTRODUCTION

Prone positioning with head rotation can influence cerebral haemodynamics, potentially affecting cerebral perfusion and oxygenation. Elderly patients with impaired brain perfusion and oxygenation are at an increased risk of developing postoperative delirium (POD). Despite this, few studies have explored whether head orientation during prone positioning contributes to POD in older adults, an aspect often overlooked by clinicians. This study aimed to evaluate the impact of head orientation during prone positioning on the incidence of POD in elderly patients undergoing thoracolumbar spine surgery.

METHODS AND ANALYSIS

This study is a single-centre, randomised, single-blind trial, with the assessors blinded to the intraoperative head position. Eligible participants are patients aged ≥65 years undergoing elective thoracolumbar spine surgery. A total of 500 patients will be randomly assigned to either the prone position with the head centred, or the prone position with the head deviated. The primary outcome is the incidence of POD, measured using the 3 min Diagnostic Interview for Confusion Assessment Method (3D-CAM) until postoperative day 5. Secondary outcomes include the severity of POD assessed by the Memorial Delirium Assessment Scale (MDAS), postoperative cognitive impairment evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), intraoperative regional cerebral oxygen saturation (rSO), changes in vertebrobasilar artery and middle cerebral artery haemodynamics, and plasma levels of calcium channel-binding protein S100 subunit beta (S100B) and neuron-specific enolase (NSE).

ETHICS AND DISSEMINATION

Ethical approval was obtained from Yancheng No. 1 People's Hospital Ethics Examination Committee (2023-K-120-01). The findings will be disseminated through presentations at annual conferences and publications in scientific journals.

TRIAL REGISTRATION NUMBER

ChiCTR2300078839.

摘要

引言

俯卧位并头部旋转会影响脑血流动力学，可能影响脑灌注和氧合。脑灌注和氧合受损的老年患者术后发生谵妄（POD）的风险增加。尽管如此，很少有研究探讨俯卧位时头部方向是否会导致老年人发生POD，而这一点往往被临床医生忽视。本研究旨在评估俯卧位时头部方向对接受胸腰椎手术的老年患者POD发生率的影响。

方法与分析

本研究是一项单中心、随机、单盲试验，评估人员对术中头部位置不知情。符合条件的参与者为年龄≥65岁接受择期胸腰椎手术的患者。总共500名患者将被随机分配至头部居中的俯卧位或头部偏向一侧的俯卧位。主要结局是POD的发生率，采用3分钟困惑评估法诊断访谈（3D-CAM）进行测量，直至术后第5天。次要结局包括使用纪念谵妄评估量表（MDAS）评估的POD严重程度、使用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MoCA）评估的术后认知障碍、术中局部脑氧饱和度（rSO）、椎基底动脉和大脑中动脉血流动力学变化，以及钙通道结合蛋白S100亚基β（S100B）和神经元特异性烯醇化酶（NSE）的血浆水平。