择期手术后老年患者的麻醉与术后谵妄：七氟醚与丙泊酚的回顾性比较
Anesthetics and Postoperative Delirium in Elderly after Elective Surgery: A Retrospective Comparison between Sevoflurane and Propofol.
作者信息
El Kerdasy Yasser Ahmed Abdelaziz, Fadl Mahmoud Ibrahim, Abdmokhles Abdelmottaleb Neazy, Montasser Ali Mahmoud Gaballah, Helmy Elsaied Mahmoud
机构信息
Department of Hepatogastroenterology, Al-Azhar Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Department of Anesthesiology, Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
出版信息
Med J Islam Repub Iran. 2025 Jan 13;39:7. doi: 10.47176/mjiri.39.7. eCollection 2025.
BACKGROUND
Postoperative delirium (POD) in elderly subjects is an important health issue as it is associated with high morbidity and mortality. Anesthetic agents are associated factors for the development of POD. However, the results of previous studies are heterogeneous. The current work aimed to determine the incidence and associated factors of POD after sevoflurane or propofol general anesthesia.
METHODS
This was a retrospective study, where data were collected from the medical records of 200 subjects scheduled for elective surgery under general anesthesia. One hundred received sevoflurane, and the other 100 received propofol. The collected data included patient characteristics and preoperative and operative data. In addition, POD and any complications developed after surgery are also included. Mean and standard deviation were used to summarize quantitative variables, while frequency and percentages were used to express categorical data. The independent sample's student test was used to compare two means, and Chi-Square was used to calculate associations between categorical parameters. Risk estimate was determined by calculation of odds ratios. value<0.05 was considered significant.
RESULTS
Operative time was significantly shorter in sevoflurane than in propofol groups (249.91±45.41 vs 264.60±45.78 minutes, respectively). Otherwise, no significant differences were recorded for preoperative and operative data. The incidence of POD was significantly higher after propofol than sevoflurane (30.0% vs 14.0%). The POD was significantly associated with higher ASA-class physical status, diabetes mellitus, and type of anesthetic agent. ASA-III was 34.1% and 10.3% in patients with delirium than without delirium. Diabetes recorded 65.9% for the group with delirium compared to 10.3% for those without delirium.
CONCLUSION
POD was higher after propofol than sevoflurane anesthesia. It is associated with ASA physical status, diabetes, and the type of anesthetic agent used.
背景
老年患者术后谵妄（POD）是一个重要的健康问题，因为它与高发病率和死亡率相关。麻醉药物是POD发生的相关因素。然而，先前研究的结果并不一致。当前研究旨在确定七氟醚或丙泊酚全身麻醉后POD的发生率及相关因素。
方法
这是一项回顾性研究，从200例计划接受全身麻醉择期手术患者的病历中收集数据。100例接受七氟醚麻醉，另100例接受丙泊酚麻醉。收集的数据包括患者特征、术前和手术数据。此外，还包括术后发生的POD及任何并发症。均值和标准差用于总结定量变量，频率和百分比用于表示分类数据。采用独立样本t检验比较两组均值，卡方检验用于计算分类参数之间的关联。通过计算比值比来确定风险估计值。P<0.05被认为具有统计学意义。
结果
七氟醚组的手术时间显著短于丙泊酚组（分别为249.91±45.41分钟和264.60±45.78分钟）。除此之外，术前和手术数据无显著差异。丙泊酚麻醉后POD的发生率显著高于七氟醚麻醉（30.0%对14.0%）。POD与较高的美国麻醉医师协会（ASA）身体状况分级、糖尿病及麻醉药物类型显著相关。谵妄患者中ASA-III级的比例为34.1%，非谵妄患者中为10.3%。谵妄组糖尿病患者比例为65.9%，非谵妄组为10.3%。
结论
丙泊酚麻醉后POD的发生率高于七氟醚麻醉。它与ASA身体状况分级、糖尿病及所用麻醉药物类型有关。
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