Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients
Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients
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DOI：
10.1093/bja/ael106
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发表时间：
2006-06-01
影响因子：
9.8
通讯作者：
Wang, Y.
中科院分区：
文献类型：
--
作者：
Leung, J. M.;Sands, L. P.;Wang, Y.
背景资料。非心脏手术后的老年外科患者，术后神志不清和认知能力下降是常见的。尽管这种发病率和临床重要性，尚未确定术后精神错乱和认知功能下降的具体病因。在大鼠模型的实验环境中，一氧化二氮(N2O)在高浓度下以年龄依赖的方式产生神经毒性作用。这种神经毒性反应是否可以在临床上观察到，以前还没有确定。我们假设，在接受非心脏手术的老年患者中，暴露于N2O会导致术后精神错乱的发生率比没有接受N2O的患者预期的要高。年龄=65岁、接受非心脏手术并需要全身麻醉的患者被随机分成两组，分别接受吸入剂和N2O加氧气或单独氧气。在手术前和术后头两天进行了一次有组织的访谈，以确定是否存在精神错乱。共有228名患者接受研究，平均年龄为73.9岁(65-95岁)。术后43.8%的患者出现妄想。多因素Logistic回归分析显示，年龄[优势比(OR)1.07；95%可信区间(CI)1.02~1.26]、依赖于进行一项或多项独立的日常生活活动(OR 1.54；95%CI 1.01~2.35)、术后使用病人自控止痛药(OR 3.75；95%CI 1.27~11.01)和苯二氮卓类药物(OR 2.29；95%CI 1.21~4.36)是术后精神障碍的独立危险因素。相反，N2O的使用与术后精神错乱无关。与不接触N2O相比，暴露在N2O中的患者术后精神错乱的发生率相同。
Background. Postoperative delirium and cognitive decline are common in elderly surgical patients after non-cardiac surgery. Despite this prevalence and clinical importance, no specific aetiological factor has been identified for postoperative delirium and cognitive decline. In experimental setting in a rat model, nitrous oxide (N2O) produces neurotoxic effect at high concentrations and in an age-dependent manner. Whether this neurotoxic response may be observed clinically has not been previously determined. We hypothesized that in the elderly patients undergoing non-cardiac surgery, exposure to N2O resulted in an increased incidence of postoperative delirium than would be expected for patients not receiving N2O.Methods. Patients who were >= 65 yr of age, undergoing non-cardiac surgery and requiring general anaesthesia were randomized to receive an inhalational agent and either N2O with oxygen or oxygen alone. A structured interview was conducted before operation and for the first two postoperative days to determine the presence of delirium using the Confusion Assessment Method.Results. A total of 228 patients were studied with a mean (range) age of 73.9 (65-95) yr. After operation, 43.8% of patients developed delirium. By multivariate logistic regression, age [odds ratio (OR) 1.07; 95% confidence interval (CI) 1.02-1.26], dependence on performing one or more independent activities of daily living (OR 1.54; 95% CI 1.01-2.35), use of patient-controlled analgesia for postoperative pain control (OR 3.75; 95% CI 1.27-11.01) and postoperative use of benzodiazepine (OR 2.29; 95% CI 1.21-4.36) were independently associated with an increased risk for postoperative delirium. In contrast, the use of N2O had no association with postoperative delirium.Conclusions. Exposure to N2O resulted in an equal incidence of postoperative delirium when compared with no exposure to N2O.