The role of postoperative analgesia in delirium and cognitive decline in elderly patients: A systematic review
The role of postoperative analgesia in delirium and cognitive decline in elderly patients: A systematic review
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DOI：
10.1213/01.ane.0000198602.29716.53
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发表时间：
2006-04-01
影响因子：
5.7
通讯作者：
Leung, JM
中科院分区：
文献类型：
--
作者：
Fong, HK;Sands, LP;Leung, JM
术后谵妄和认知能力下降是老年患者常见的不良事件。既存患者因素、药物以及各种术中和术后原因与术后谵妄和认知功能下降的发生有关。尽管先前的研究将术后疼痛确定为风险因素，但相对较少的临床研究比较了常见的术后疼痛管理技术（IV和硬膜外）或阿片类镇痛药对术后认知状态的影响。系统检索PubMed和CINAHL数据库，发现6项研究比较了不同阿片类镇痛药对术后谵妄和认知能力下降的影响，5项研究比较了IV和硬膜外给药镇痛途径。哌替啶一直与老年手术患者谵妄风险增加相关，但目前的证据并未显示术后谵妄或认知能力下降与其他更常用的术后阿片类药物（如吗啡、芬太尼或氢吗啡酮）之间存在显著差异。现有的研究还表明，静脉或硬膜外技术不会影响认知功能不同。然而，未来的调查，足够的研究规模和更标准化的方法来定义结果是必要的，以确认目前的研究结果。
Postoperative delirium and cognitive decline are adverse events that occur frequently in elderly patients. Preexisting patient factors, medications, and various intraoperative and postoperative causes have been implicated in the development of postoperative delirium and cognitive decline. Despite previous studies identifying postoperative pain as a risk factor, relatively few clinical studies have compared the effect of common postoperative pain management techniques (IV and epidural) or opioid analgesics on postoperative cognitive status. A systematic search of the PubMed and CINAHL databases identified six studies comparing different opioid analgesics on postoperative delirium and cognitive decline and five studies comparing IV and epidural routes of administering analgesia. Meperidine was consistently associated with an increased risk of delirium in elderly surgical patients, but the current evidence has not shown a significant difference in postoperative delirium or cognitive decline among other more frequently used postoperative opioids such as morphine, fentanyl, or hydromorphone. The available studies also suggest that IV or epidural techniques do not influence cognitive function differently. However, future investigations of sufficient study size and more standardized methods of defining outcomes are necessary to confirm the current findings.