摘要
目的探讨高压氧联合奥氮平治疗全关节置换老年患者麻醉术后谵妄的临床疗效。方法选取2021年7月至2023年7月于郴州市第一人民医院接受静脉全麻下全关节置换术后发生谵妄的老年患者104例作为研究对象,根据术后患者谵妄的治疗方法分为观察组(n=56)和对照组(n=48)。对照组患者在对症治疗的基础上给予奥氮平治疗,观察组在对照组的基础上联合高压氧治疗。采用意识混乱评估法(CAM)识别和评估2组患者治疗前后的谵妄状态;采用简易精神状态检查表(MMSE)评估2组患者治疗前后的意识水平及精神状态。记录2组患者治疗期间每日睡眠时间及术后谵妄持续时间。采用酶联免疫吸附法检测2组患者治疗前后血浆补体1 q(C1q)、补体3b(C3b)及血清脑源性神经营养因子(BDNF)、神经颗粒素的表达水平。统计2组患者治疗期间不良反应发生情况。结果与治疗前相比,2组患者治疗后CAM评分明显降低,MMSE评分明显提高(均P<0.01);治疗后观察组患者CAM评分明显低于对照组,MMSE评分明显高于对照组(均P<0.05)。观察组患者治疗期间每日睡眠时间长于对照组[(7.01±1.54)h vs.(5.98±2.16)h,P<0.01],术后谵妄持续时间短于对照组[(148.26±46.31)h vs.(187.18±53.84)h,P<0.01]。与治疗前相比,2组患者治疗后血浆C1q、C3b水平均明显降低(均P<0.01),且治疗后观察组均明显低于对照组(均P<0.05)。与治疗前相比,观察组患者治疗后血清BNDF水平明显升高,神经颗粒素水平明显降低(均P<0.01),且治疗后观察组BNDF水平明显高于对照组,神经颗粒素水平明显低于对照组(均P<0.05)。观察组患者治疗过程中不良反应发生率(8.93%,5/56)与对照组(6.25%,3/48)比较,差异无统计学意义(P>0.05)。结论高压氧联合奥氮平治疗能明显降低全关节置换麻醉术后谵妄患者的严重程度,缩短术后谵妄持续时间,延长睡眠时间,且安全性良好。
Objective To analyze the clinical efficacy of hyperbaric oxygen combined with olanzapine in the treatment of delirium in elderly patients after anesthesia for total joint replacement.Methods A total of 104 elderly patients with delirium after joint replacement under intravenous general anesthesia in the First People’s Hospital of Chenzhou from July 2021 to July 2023 were selected as the research objects.According to the treatments for postoperative delirium,those patients were divided into observation group(n=56)and control group(n=48).The control group was given olanzapine for symptomatic treatment,while the observation group was additionally given hyperbaric oxygen therapy on the basis of the treatment of the control group.Confusion assessment method(CAM)was used to identify and evaluate delirium of the patients in the two groups before and after treatment.Mini-mental state examination(MMSE)was used to evaluate the consciousness level and mental state of the patients before and after treatment.The daily sleep time and duration of postoperative delirium during treatment were recorded in the two groups.Enzyme-linked immunosorbent assay was used to detect the expression levels of plasma complement 1q(C1q),complement 3b(C3b),Brain-derived neurotrophic factor(BDNF),and neurogranin in the two groups before and after treatment.The incidence of adverse reactions during treatment in the two groups was recorded.Results After treatment,the CAM scores were significantly decreased and the MMSE scores were significantly increased in the two groups after treatment(all P<0.01).After treatment,the CAM score of the observation group was significantly lower than that of the control group,and the MMSE score was significantly higher than that of the control group(all P<0.05).The daily sleep time of the observation group was longer than that of the control group during treatment[(7.01±1.54)h vs.(5.98±2.16)h,P<0.01]The duration of postoperative delirium was shorter than that of control group[(148.26±46.31)h vs.(187.18±53.84)h,P<0.01].After treatment,the levels of C1q and C3b in the two groups were significantly decreased(all P<0.01),and the above indexes in the observation group were significantly lower than those in the control group after treatment(all P<0.05).After treatment,the plasma BNDF level in the observation group was significantly increased and the neurogranin level was significantly decreased(all P<0.01),and the BNDF level in the observation group was significantly higher than that in the control group,while the neurogranin level was significantly lower than that in the control group after treatment(all P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group(8.93%,5/56)and the control group(6.25%,3/48)(P>0.05).Conclusion Hyperbaric oxygen combined with olanzapine can significantly reduce the severity of delirium in patients after total joint replacement anesthesia,shorten the duration of postoperative delirium,and prolong sleep time,with good safety.
作者
李松林
李贤
胡黎黎
Li Songlin;Li Xian;Hu Lili(Department of Anesthesiology,The First People’s Hospital of Chenzhou,Chenzhou 423000,China)
出处
《中华航海医学与高气压医学杂志》
2025年第3期291-295,共5页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
关键词
术后谵妄
全关节置换
高压氧
奥氮平
Postoperative delirium
Total joint replacement
Hyperbaric oxygen
Olanzapine
