Chen Xiaoyi, Wang Xinghe, Liu Yucheng, Guo Jie, Yin Tianyu, Chen Junda, Chen Yangyang, Wang Keqin, Zhang Yuqi, Zhang Ziqian, Zhao Linlin, Wu Yan, Liu Su
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China.
Int J Surg. 2025 Sep 1;111(9):6191-6199. doi: 10.1097/JS9.0000000000002762. Epub 2025 Jun 20.
Tourniquet is widely used in total knee arthroplasty (TKA), but its impact on postoperative delirium (POD) remains unclear. The purposes of this study were to investigate the impact of tourniquet application on POD in elderly patients TKA and to explore the possible mechanisms associated with POD.
In this prospective, single-center randomized clinical trial study, 313 patients scheduled for single TKA under general anesthesia were randomly assigned to groups with or without a limb tourniquet. The primary outcome was the incidence of POD within postoperative 7 days. Secondary outcomes were the levels of hypoxia-inducible factor-1α (HIF-1α), tumor necrosis factor-alpha, superoxide dismutase (SOD), and S100β protein (S100β) measured postoperative 30 minutes and 24 hours, blood loss, pain score, the time to first postoperative ambulation, postoperative hospitalization, postoperative complications, and adverse events.
The incidence of POD in tourniquet group was significantly higher than that in no tourniquet group (19.1% vs. 9.6%, relative risk 1.12, 95% confidence interval: 1.02-1.23, P = 0.018). The serum level of HIF-1α was higher at postoperative 30 minutes and 24 hours and SOD was lower at postoperative 24 hours in tourniquet group compared with no tourniquet group. The incidence of postoperative complications and adverse events were comparable in both groups.
We concluded that tourniquet application during TKA increased the incidence of POD within postoperative 7 days in older patients, and increased serum level of HIF-1α and decreased level of SOD, which indicated that they may be potential targets for preventing and treating POD.
止血带在全膝关节置换术（TKA）中广泛应用，但其对术后谵妄（POD）的影响尚不清楚。本研究旨在探讨止血带应用对老年TKA患者POD的影响，并探究与POD相关的可能机制。
在这项前瞻性、单中心随机临床试验研究中，313例计划在全身麻醉下行单膝关节置换术的患者被随机分为使用或不使用肢体止血带组。主要结局是术后7天内POD的发生率。次要结局包括术后30分钟和24小时测量的缺氧诱导因子-1α（HIF-1α）、肿瘤坏死因子-α、超氧化物歧化酶（SOD）和S100β蛋白（S100β）水平、失血量、疼痛评分、术后首次下床活动时间、术后住院时间、术后并发症及不良事件。
止血带组POD的发生率显著高于无止血带组（19.1%对9.6%，相对危险度为1.12，95%置信区间：1.02 - 1.23，P = 0.018）。与无止血带组相比，止血带组术后30分钟和24小时血清HIF-1α水平较高，术后24小时SOD水平较低。两组术后并发症和不良事件的发生率相当。
我们得出结论，TKA术中应用止血带会增加老年患者术后7天内POD的发生率，且血清HIF-1α水平升高和SOD水平降低，这表明它们可能是预防和治疗POD的潜在靶点。
