麻醉药物相关的术后谵妄影响因素分析

叶 枫, 1. 华北, 王攀 1., 王伟 业1, 张满 和通

摘要

摘要：目的:术后谵妄(postoperative delirium，POD）[1]是指患者在经历外科手术后 1 周内出现的谵妄是一种急性发作且病程短暂的脑功能障碍，其
特点是注意力障碍、意识水平紊乱和认知功能改变，并有明显的波动性。其发生具有明显的时间特点，主要发生在术后 24h～72h 以内。POD
是术后最常出现的围术期中枢神经系统并发症之一，常见于年龄大于 65 岁老年人，特别是手术前已有神经、精神合并症的老年人。术后谵妄
对患者早期和远期预后都有不良影响。谵妄患者术后并发症发生风险增加 2~3 倍、围术期死亡风险增加 2~3 倍，且住院时间延长和住院期间医
疗费用增加。随着现代麻醉学的发展，麻醉药物及辅助用药的种类越来越丰富，术中麻醉药物的选择和使用与术后 POD 的发生有着密切相关
关系，本文将就麻醉药物对术后 POD 影响的研究进展进行综述。

关键词

关键词：术后谵妄；麻醉药物；危险因素；围术期；药理学

参考

[1]米卫东, 王国林. 中国老年患者术后谵妄防治专家共识[J].

国际麻醉学与复苏杂志, 2023, 44(1): 1-27.

[2]周晨曦, 汪晖, 吴前胜, 等. 体外循环下心血管手术患者术

后谵妄发生情况及影响因素分析[J]. 四川大学学报(医学版), 2023,

54(4): 752-758.

[3]廖玉麟, 谢冬梅, 岳冀蓉, 等. 老年非心脏手术术后谵妄发

生率及危险因素分析[J]. 实用老年医学, 2019, 33(2): 115-120.

[4]LIU B, HUANG D, GUO Y, et al. Recent advances and

perspectives of postoperative neurological disorders in the elderly

surgical patients[J]. CNS Neuroscience & Therapeutics, 2022, 28(4):

470-483.

[5]EVERED L A, CHAN M T V, HAN R, et al. Anaesthetic depth

and delirium after major surgery: a randomised clinical trial[J]. British

Journal of Anaesthesia, 2021, 127(5): 704-712.

[6]AHRENS E, TARTLER T M, SULEIMAN A, et al.

Dose-dependent relationship between intra-procedural hypoxaemia or

hypocapnia and postoperative delirium in older patients[J]. British

Journal of Anaesthesia, 2023, 130(2): e298-e306.

[7]WACHTENDORF L J, AZIMARAGHI O, SANTER P, et al.

Association Between Intraoperative Arterial Hypotension and Postoperative

Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort

Study[J]. Anesthesia & Analgesia, 2022, 134(4): 822-833.

[8]JU J-W, NAM K, SOHN J Y, et al. Association between

intraoperative body temperature and postoperative delirium: A retrospective

observational study[J]. Journal of Clinical Anesthesia, 2023, 87: 111107.

[9]KIM S, CHOI E, JUNG Y, et al. Postoperative delirium screening

tools for post‐anaesthetic adult patients in non‐intensive care units: A

systematic review and meta‐analysis[J]. Journal of Clinical Nursing,

2023, 32(9-10): 1691-1704.

[10]TRAN J, NIMOJAN T, SARIPELLA A, et al. Rapid cognitive

assessment tools for screening of mild cognitive impairment in the

preoperative setting: A systematic review and meta-analysis[J]. Journal of

Clinical Anesthesia, 2022, 78: 110682.

[11]NOAH A M, ALMGHAIRBI D, EVLEY R, et al. Preoperative

inflammatory mediators and postoperative delirium: systematic review

and meta-analysis[J]. British Journal of Anaesthesia, 2021, 127(3):

424-434.

[12]MEYBURG J, RITSERT M-L, TRAUBE C, et al.

Cholinesterases and Anticholinergic Medications in Postoperative

Pediatric Delirium[J]. Pediatric Critical Care Medicine, 2020, 21(6):

535-542.

[13]陈钢, 王宏伟. 全麻药物的神经作用机制研究[J]. 浙江医学,

2022, 44(15): 1575-1578+1585.

[14]VAN NORDEN J, SPIES C D, BORCHERS F, et al. The effect

of peri‐operative dexmedetomidine on the incidence of postoperative

delirium in cardiac and non‐cardiac surgical patients: a randomised,

double‐blind placebo‐controlled trial[J]. Anaesthesia, 2021, 76(10):

1342-1351.

[15]WEI W, ZHANG A, LIU L, et al. Effects of subanaesthetic

S-ketamine on postoperative delirium and cognitive function in elderly

patients undergoing non-cardiac thoracic surgery: a protocol for a

randomised, double-blinded, placebo-controlled and positive-controlled,

non-inferiority trial (SKED trial)[J]. BMJ Open, 2022, 12(8): e061535.

[16]SUBRAMANIAM B, SHANKAR P, SHAEFI S, et al. Effect of

Intravenous Acetaminophen vs Placebo Combined With Propofol or

Dexmedetomidine on Postoperative Delirium Among Older Patients

Following Cardiac Surgery: The DEXACET Randomized Clinical Trial[J].

JAMA, 2019, 321(7): 686.

[17]蒋加丽, 何蕾蕾, 代顺慧, 等. 麻醉药物对心脏手术患者术

后谵妄影响的研究[J]. 中国胸心血管外科临床杂志, 2021, 28(5):

565-570.

[18]CAO S-J, ZHANG Y, ZHANG Y-X, et al. Delirium in older

patients given propofol or sevoflurane anaesthesia for major cancer

surgery: a multicentre randomised trial[J]. British Journal of Anaesthesia,

2023, 131(2): 253-265.

[19]TAYLOR J, PAYNE T, CASEY C, et al. Sevoflurane dose and

postoperative delirium: a prospective cohort analysis[J]. British Journal of

Anaesthesia, 2023, 130(2): e289-e297.

[20]RADTKE F, FRANCK M, LORENZ M, et al. Remifentanil

Reduces the Incidence of Post-Operative Delirium[J]. Journal of

International Medical Research, 2010, 38(4): 1225-1232.

作者简介：姓名：叶枫 性别：女 学历：硕士 研究方向：术

后谵妄 籍贯：河北省衡水市

通讯作者：姓名：张满和 性别：男 学历：博士 研究方向：

小儿麻醉 老年麻醉 介入麻醉 籍贯：河北省唐山市 主任医师

硕士生导师