Objective Postoperative delirium(POD)has become a critical challenge with severe consequences and increased incidences as the global population ages.However,the underlying mechanism is yet unknown.Our study aimed to e...Objective Postoperative delirium(POD)has become a critical challenge with severe consequences and increased incidences as the global population ages.However,the underlying mechanism is yet unknown.Our study aimed to explore the changes in metabolites in three specific brain regions and saliva of older mice with postoperative delirium behavior and to identify potential non-invasive biomarkers.Methods Eighteen-month-old male C57/BL6 mice were randomly assigned to the anesthesia/surgery or control group.Behavioral tests were conducted 24 h before surgery and 6,9,and 24 h after surgery.Complement C3(C3)and S100 calcium-binding protein B protein(S100beta)levels were measured in the hippocampus,and a metabolomics analysis was performed on saliva,hippocampus,cortex,and amygdala samples.Results In total,43,33,38,and 14 differential metabolites were detected in the saliva,hippocampus,cortex,and amygdala,respectively.“Pyruvate”“alpha-linolenic acid”and“2-oleoyl-1-palmitoy-snglycero-3-phosphocholine”are enriched in one common pathway and may be potential non-invasive biomarkers for POD.Common changes were observed in the three brain regions,with the upregulation of 1-methylhistidine and downregulation of D-glutamine.Conclusion Dysfunctions in energy metabolism,oxidative stress,and neurotransmitter dysregulation are implicated in the development of POD.The identification of changes in the level of salivary metabolite biomarkers could aid in the development of noninvasive diagnostic methods for POD.展开更多
Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of posto...Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.展开更多
Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of ...Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.展开更多
BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium.Previously,clinical trials did not reach definite conclusions on the effects of statins on delirium.So...BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium.Previously,clinical trials did not reach definite conclusions on the effects of statins on delirium.Some clinical trials have indicated that statins reduce postoperative delirium and improve outcomes,while some studies have reported negative results.AIM To evaluate whether perioperative rosuvastatin treatment reduces the incidence of delirium and improves clinical outcomes.METHODS This randomized,double-blind,and placebo-controlled trial was conducted in a single center in Jiangsu,China.This study enrolled patients aged greater than 60 years who received general anesthesia during elective operations and provided informed consent.A computer-generated randomization sequence(in a 1:1 ratio)was used to randomly assign patients to receive either rosuvastatin(40 mg/d)or placebo.Participants,care providers,and investigators were all masked to group assignments.The primary endpoint was the incidence of delirium,which was assessed twice daily with the Confusion Assessment Method during the first 7 postoperative days.Analyses were performed on intention-to-treat and safety populations.RESULTS Between January 1,2017 and January 1,2020,3512 patients were assessed.A total of 821 patients were randomly assigned to receive either placebo(n=411)or rosuvastatin(n=410).The incidence of postoperative delirium was significantly lower in the rosuvastatin group[23(5.6%)of 410 patients]than in the placebo group{42(13.5%)of 411 patients[odds ratios(OR)=0.522,95%confidence interval(CI):0.308-0.885;P<0.05]}.No significant difference in 30-d all-cause mortality(6.1%vs 8.7%,OR=0.67,95%CI:0.39-1.2,P=0.147)was observed between the two groups.Rosuvastatin decreased the hospitalization time(13.8±2.5 vs 14.2±2.8,P=0.03)and hospitalization expenses(9.3±2.5 vs 9.8±2.9,P=0.007).No significant differences in abnormal liver enzymes(9.0%vs 7.1%,OR=1.307,95%CI:0.787-2.169,P=0.30)or rhabdomyolysis(0.73%vs 0.24%,OR=3.020,95%CI:0.31-29.2,P=0.37)were observed between the two groups.CONCLUSION The current study suggests that perioperative rosuvastatin treatment reduces the incidence of delirium after an elective operation under general anesthesia.However,the evidence does not reveal that rosuvastatin improves clinical outcomes.The therapy is safe.Further investigation is necessary to fully understand the potential usefulness of rosuvastatin in elderly patients.展开更多
Postoperative delirium(PD)is a common complication of surgery in elderly patients,but its pathophysiological mechanism remains unclear.In order to clarify the role of intraoperative hypotension and fluctuation of bloo...Postoperative delirium(PD)is a common complication of surgery in elderly patients,but its pathophysiological mechanism remains unclear.In order to clarify the role of intraoperative hypotension and fluctuation of blood pressure in the development of PD,we conducted a follow-up study in elderly patients with intraoperative hypotension and fluctuation of blood pressure.A total of 237 patients underwent hip surgery between July 2018 and September 2019,and 158 patients who were eligible for inclusion were enrolled in the study.One day before the operation,the mentality of patients was evaluated by Mini-mental State Examination(MMSE),and the sex,age,height,and weight of the patients were recorded.Radial artery puncture was performed in all patients before anesthesia,intraoperative SBP,MAP and DBP were recorded,and the surgical events of the patients was recorded.The markers associated with PD(TNF-α,IL-6 and S-100β)were determined before and after surgery.Perioperative delirium(PD)was assessed by the prevailing standard of assessment,Confusion of Consciousness Assessment(CAM).Cognitive assessment was evaluated using the Mini-mental State Examination(MMSE).In addition,the timing and type of delirium were recorded.There were 158 patients which were accorded with the inclusion criteria came into the study.The results of our data showed that delirium occurred in 41 patients(25.9%)during the first week after surgery.In the comparison between the PD group and the non-PD group,it was found that the patients with postoperative delirium were older,lower body mass index and higher MMSE score before operation.Intraoperative blood pressure is low,usually more than 30%lower than preoperative blood pressure.The levels of TNF-α,IL-6 and Smur100βwere higher after operation.The increased incidence of postoperative delirium may be related to intraoperative hypotension and intraoperative blood pressure fluctuation.The pathophysiological mechanism may be that hypotension causes low cerebral perfusion,which in turn causes local inflammation in the brain.In addition,postoperative delirium is also more likely to occur in older patients with lower body mass index.展开更多
BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling techn...BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.展开更多
BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgentl...BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.展开更多
BACKGROUND After cardiac and non-cardiac surgeries,elderly patients have a high probability of developing cardiac complications and postoperative delirium.Although several clinical trials have investigated whether per...BACKGROUND After cardiac and non-cardiac surgeries,elderly patients have a high probability of developing cardiac complications and postoperative delirium.Although several clinical trials have investigated whether perioperative intravenous dexmedetomidine can protect the heart and reduce postoperative complications such as delirium in elderly patients,the obtained results have been inconsistent.We conducted a meta-analysis to investigate the effects of dexmedetomidine on cardioprotection and other postoperative complications in elderly patients undergoing cardiac or non-cardiac surgery.AIM To investigate the effects of dexmedetomidine on cardiac complications and delirium in elderly patients undergoing cardiac or non-cardiac surgery.METHODS The PubMed,Cochrane Library,web of science,and other sources were comprehensively searched for all randomized controlled trials published before May 2021 that investigated the efficacy of dexmedetomidine in the prevention of cardiac and postoperative delirium(POD).RESULTS In total,18 studies involving 1025 patients were included in the meta-analysis.Intravenous dexmedetomidine significantly reduced cardiac troponin I(cTnI)and the inflammatory factor tumor necrosis factor-α(TNF-α)was comparable to the control group.Dexmedetomidine also reduced the POD and mortality rates.However,patients in the dexmedetomidine group were more likely to have a decreased heart rate(within the normal range)and hypotension during dexmedetomidine administration than those in the control group.There was no difference in the occurrence of myocardial infarction,bradycardia,or stroke between the two groups.Dexmedetomidine significantly shortened the time to extubate;however,it did not shorten the length of stay in the intensive care unit.CONCLUSION The administration of dexmedetomidine during cardiac and non-cardiac surgeries can provide myocardial protection by inhibiting inflammation and cTnI,which may be beneficial for the rapid recovery of patients.Meanwhile,the administration of dexmedetomidine reduced the incidence of POD and decreased mortality(in-hospital).展开更多
Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery fr...Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery from anesthesia,complications,and mortality.Methods:PubMed,EMBASE,and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients.The co-primary outcomes were postoperative pain and delirium(assessed using the confusion assessment method).We conducted a meta-analysis using a random-effects model.We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression.We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment,Development and Evaluation(GRADE)methodology.We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results:A total of 26 trials with 10,743 patients were included.Deep anesthesia compared with light anesthesia(a mean difference in bispectral index of-12 to-11)was associated with lower pain scores at rest at 0 to 1 h postoperatively(weighted mean difference=-0.72,95%confidence interval[CI]=-1.25 to-0.18,P=0.009;moderate-quality evidence)and an increased incidence of postoperative delirium(24.95%vs.15.92%;risk ratio=1.57,95%CI=1.28-1.91,P<0.0001;high-quality evidence).No publication bias was detected.For the exploratory secondary outcomes,deep anesthesia was associated with prolonged postoperative recovery,without affecting neurocognitive outcomes,major complications,or mortality.In the subgroup analyses,the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively,without statistically significant subgroup differences,and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries,without statistically significant subgroup differences.Conclusions:Deep anesthesia reduced early postoperative pain but increased postoperative delirium.The current evidence does not support the use of deep anesthesia in clinical practice.展开更多
基金funded by the Natural Science Foundation of Beijing(7212023)the National Natural Science Foundation of China(82071180)to HHMthe National Natural Science Foundation of China(82271206)to TZL。
文摘Objective Postoperative delirium(POD)has become a critical challenge with severe consequences and increased incidences as the global population ages.However,the underlying mechanism is yet unknown.Our study aimed to explore the changes in metabolites in three specific brain regions and saliva of older mice with postoperative delirium behavior and to identify potential non-invasive biomarkers.Methods Eighteen-month-old male C57/BL6 mice were randomly assigned to the anesthesia/surgery or control group.Behavioral tests were conducted 24 h before surgery and 6,9,and 24 h after surgery.Complement C3(C3)and S100 calcium-binding protein B protein(S100beta)levels were measured in the hippocampus,and a metabolomics analysis was performed on saliva,hippocampus,cortex,and amygdala samples.Results In total,43,33,38,and 14 differential metabolites were detected in the saliva,hippocampus,cortex,and amygdala,respectively.“Pyruvate”“alpha-linolenic acid”and“2-oleoyl-1-palmitoy-snglycero-3-phosphocholine”are enriched in one common pathway and may be potential non-invasive biomarkers for POD.Common changes were observed in the three brain regions,with the upregulation of 1-methylhistidine and downregulation of D-glutamine.Conclusion Dysfunctions in energy metabolism,oxidative stress,and neurotransmitter dysregulation are implicated in the development of POD.The identification of changes in the level of salivary metabolite biomarkers could aid in the development of noninvasive diagnostic methods for POD.
文摘Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.
基金The study was funded by the Committee of Health and Family Planning of Shanghai,China(project number 201440100)
文摘Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.
文摘BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium.Previously,clinical trials did not reach definite conclusions on the effects of statins on delirium.Some clinical trials have indicated that statins reduce postoperative delirium and improve outcomes,while some studies have reported negative results.AIM To evaluate whether perioperative rosuvastatin treatment reduces the incidence of delirium and improves clinical outcomes.METHODS This randomized,double-blind,and placebo-controlled trial was conducted in a single center in Jiangsu,China.This study enrolled patients aged greater than 60 years who received general anesthesia during elective operations and provided informed consent.A computer-generated randomization sequence(in a 1:1 ratio)was used to randomly assign patients to receive either rosuvastatin(40 mg/d)or placebo.Participants,care providers,and investigators were all masked to group assignments.The primary endpoint was the incidence of delirium,which was assessed twice daily with the Confusion Assessment Method during the first 7 postoperative days.Analyses were performed on intention-to-treat and safety populations.RESULTS Between January 1,2017 and January 1,2020,3512 patients were assessed.A total of 821 patients were randomly assigned to receive either placebo(n=411)or rosuvastatin(n=410).The incidence of postoperative delirium was significantly lower in the rosuvastatin group[23(5.6%)of 410 patients]than in the placebo group{42(13.5%)of 411 patients[odds ratios(OR)=0.522,95%confidence interval(CI):0.308-0.885;P<0.05]}.No significant difference in 30-d all-cause mortality(6.1%vs 8.7%,OR=0.67,95%CI:0.39-1.2,P=0.147)was observed between the two groups.Rosuvastatin decreased the hospitalization time(13.8±2.5 vs 14.2±2.8,P=0.03)and hospitalization expenses(9.3±2.5 vs 9.8±2.9,P=0.007).No significant differences in abnormal liver enzymes(9.0%vs 7.1%,OR=1.307,95%CI:0.787-2.169,P=0.30)or rhabdomyolysis(0.73%vs 0.24%,OR=3.020,95%CI:0.31-29.2,P=0.37)were observed between the two groups.CONCLUSION The current study suggests that perioperative rosuvastatin treatment reduces the incidence of delirium after an elective operation under general anesthesia.However,the evidence does not reveal that rosuvastatin improves clinical outcomes.The therapy is safe.Further investigation is necessary to fully understand the potential usefulness of rosuvastatin in elderly patients.
文摘Postoperative delirium(PD)is a common complication of surgery in elderly patients,but its pathophysiological mechanism remains unclear.In order to clarify the role of intraoperative hypotension and fluctuation of blood pressure in the development of PD,we conducted a follow-up study in elderly patients with intraoperative hypotension and fluctuation of blood pressure.A total of 237 patients underwent hip surgery between July 2018 and September 2019,and 158 patients who were eligible for inclusion were enrolled in the study.One day before the operation,the mentality of patients was evaluated by Mini-mental State Examination(MMSE),and the sex,age,height,and weight of the patients were recorded.Radial artery puncture was performed in all patients before anesthesia,intraoperative SBP,MAP and DBP were recorded,and the surgical events of the patients was recorded.The markers associated with PD(TNF-α,IL-6 and S-100β)were determined before and after surgery.Perioperative delirium(PD)was assessed by the prevailing standard of assessment,Confusion of Consciousness Assessment(CAM).Cognitive assessment was evaluated using the Mini-mental State Examination(MMSE).In addition,the timing and type of delirium were recorded.There were 158 patients which were accorded with the inclusion criteria came into the study.The results of our data showed that delirium occurred in 41 patients(25.9%)during the first week after surgery.In the comparison between the PD group and the non-PD group,it was found that the patients with postoperative delirium were older,lower body mass index and higher MMSE score before operation.Intraoperative blood pressure is low,usually more than 30%lower than preoperative blood pressure.The levels of TNF-α,IL-6 and Smur100βwere higher after operation.The increased incidence of postoperative delirium may be related to intraoperative hypotension and intraoperative blood pressure fluctuation.The pathophysiological mechanism may be that hypotension causes low cerebral perfusion,which in turn causes local inflammation in the brain.In addition,postoperative delirium is also more likely to occur in older patients with lower body mass index.
基金Supported by Discipline Advancement Program of Shanghai Fourth People’s Hospital,No.SY-XKZT-2020-2013.
文摘BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.
基金Supported by the Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2020FYYX211Medical Research Project of Wanzhou District(Joint Project of Health Commission and Science and Technology Bureau),No.wzstc-kw2020023.
文摘BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.
文摘BACKGROUND After cardiac and non-cardiac surgeries,elderly patients have a high probability of developing cardiac complications and postoperative delirium.Although several clinical trials have investigated whether perioperative intravenous dexmedetomidine can protect the heart and reduce postoperative complications such as delirium in elderly patients,the obtained results have been inconsistent.We conducted a meta-analysis to investigate the effects of dexmedetomidine on cardioprotection and other postoperative complications in elderly patients undergoing cardiac or non-cardiac surgery.AIM To investigate the effects of dexmedetomidine on cardiac complications and delirium in elderly patients undergoing cardiac or non-cardiac surgery.METHODS The PubMed,Cochrane Library,web of science,and other sources were comprehensively searched for all randomized controlled trials published before May 2021 that investigated the efficacy of dexmedetomidine in the prevention of cardiac and postoperative delirium(POD).RESULTS In total,18 studies involving 1025 patients were included in the meta-analysis.Intravenous dexmedetomidine significantly reduced cardiac troponin I(cTnI)and the inflammatory factor tumor necrosis factor-α(TNF-α)was comparable to the control group.Dexmedetomidine also reduced the POD and mortality rates.However,patients in the dexmedetomidine group were more likely to have a decreased heart rate(within the normal range)and hypotension during dexmedetomidine administration than those in the control group.There was no difference in the occurrence of myocardial infarction,bradycardia,or stroke between the two groups.Dexmedetomidine significantly shortened the time to extubate;however,it did not shorten the length of stay in the intensive care unit.CONCLUSION The administration of dexmedetomidine during cardiac and non-cardiac surgeries can provide myocardial protection by inhibiting inflammation and cTnI,which may be beneficial for the rapid recovery of patients.Meanwhile,the administration of dexmedetomidine reduced the incidence of POD and decreased mortality(in-hospital).
基金Jiangsu Government Scholarship for Overseas Studies(No.JS-2018-178)Six Talent Peaks Project in Jiangsu Province(No.WSN-022)。
文摘Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery from anesthesia,complications,and mortality.Methods:PubMed,EMBASE,and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients.The co-primary outcomes were postoperative pain and delirium(assessed using the confusion assessment method).We conducted a meta-analysis using a random-effects model.We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression.We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment,Development and Evaluation(GRADE)methodology.We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results:A total of 26 trials with 10,743 patients were included.Deep anesthesia compared with light anesthesia(a mean difference in bispectral index of-12 to-11)was associated with lower pain scores at rest at 0 to 1 h postoperatively(weighted mean difference=-0.72,95%confidence interval[CI]=-1.25 to-0.18,P=0.009;moderate-quality evidence)and an increased incidence of postoperative delirium(24.95%vs.15.92%;risk ratio=1.57,95%CI=1.28-1.91,P<0.0001;high-quality evidence).No publication bias was detected.For the exploratory secondary outcomes,deep anesthesia was associated with prolonged postoperative recovery,without affecting neurocognitive outcomes,major complications,or mortality.In the subgroup analyses,the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively,without statistically significant subgroup differences,and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries,without statistically significant subgroup differences.Conclusions:Deep anesthesia reduced early postoperative pain but increased postoperative delirium.The current evidence does not support the use of deep anesthesia in clinical practice.
