A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery
A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery
复制标题
DOI：
10.1007/s005950200044
复制
发表时间：
2002-01-01
期刊：
影响因子：
2.5
通讯作者：
Yamamoto, T
中科院分区：
文献类型：
--
作者：
Aizawa, KI;Kanai, T;Yamamoto, T
目的。众所周知，术后谵妄（POD）是老年患者重大手术过程中最严重的并发症之一。据报道，睡眠-觉醒周期紊乱是 POD 的关键因素之一，因此我们对 42 名接受开腹手术切除胃癌或结肠癌的老年患者进行了一项前瞻性随机研究，试图阐明手术后使用药物改善睡眠-觉醒周期紊乱预防 POD 的有效性。方法。无谵妄方案（DFP）组每晚 20:00 肌肉注射地西泮。以及术后前三个晚上连续静脉输注氟硝西泮和哌替啶超过8小时，两名患者因未能完成DFP而被排除。结果。非DFP组POD的发生率为7/20（35.0%），DFP组为1/20（5.0%）。这种差异是显着的（P = 0.023）。在 DFP 组中，40% 的人观察到 DFP 造成的早晨昏昏欲睡；然而。没有看到其他副作用。结论。这些研究结果表明，DFP 治疗可有效控制普通手术后老年患者的 POD，并且似乎与严重并发症或副作用无关。据我们所知，这是第一份提出通过药物人工控制睡眠觉醒节律作为预防老年患者 POD 的方法的报告。
Purpose. Postoperative delirium (POD) is known to be one of the most critical complications of major operative procedures in elderly patients. Since disorders of the sleep-wake cycle have been reported to be one of the key factors in POD, we attempted to clarify the effectiveness of improving sleep-wake cycle disorders with medication after surgery to prevent POD, by conducting a prospective randomized study of 42 elderly patients who underwent resection of either gastric or colon cancer through an open laparotomy.Methods. The delirium-free protocol (DFP) group was given an intramuscular injection of diazepam at 20:00 h each night. as well as a continuous intravenous infusion of flunitrazepam and pethidine administered over 8 h, for the first three nights postoperatively, Two patients were excluded because of failure to complete the DFP.Results. The incidence of POD was 7/20 (35.0%) in the non-DFP group and 1/20 (5.0%) in the DFP group. this difference being significant (P = 0.023). Morning lethargy produced by the DFP was observed in 40% of the DFP group; however. no other side effects were seen.Conclusions. These findings indicate that DFP treatment is effective for controlling POD in elderly patients after general surgery and does not appear to be associated with severe complications or side effects. To our knowledge, this is the first report proposing artificial control of the sleep-awake rhythm by medication as a means of preventing POD in elderly patients.