氢气吸入对老年患者髋部骨折术后谵妄的影响

Effect of hydrogen inhalation on postoperative delirium in elderly patients with hip fracture

目的:探讨对老年患者髋部骨折术后谵妄(POD)实施H_(2)吸入治疗方案的临床优势。方法:选取80例老年髋部骨折手术患者,依据治疗方案的差异均分为两组。纳入40例患者于对照组中(予33%O_(2)吸入方案,于H_(2)吸入前、吸入0.5 h对其动脉血气进行测定),纳入40例患者于观察组中(在麻醉前、术后即刻各时间点,予以67%H_(2)+33%O_(2)的混合气体吸入1 h),于术前H_(2)吸入前、术后吸入H_(2)后第1天,第3天等不同时间点对患者动脉血进行采集,对白细胞介素(IL)-6、超氧化物歧化酶(SOD)活性进行观察评估。并对两组术后7 d POD的发生情况进行评估对比。结果:经对两组H_(2)吸入前、吸入0.5 h的pH、PaO_(2)、PaCO_(2)等各项动脉血气指标进行评测,差异无统计学意义(P>0.05)。两组术后吸入H_(2)后第1天,第3天不同时间点的IL-6浓度相比于术前H_(2)吸入前均居于明显升高水平,SOD活性相比于术前H_(2)吸入前均居于明显减弱趋势(P<0.05);观察组术后吸入H_(2)后第1天,第3天时不同时间点的IL-6浓度相比于对照组均居于明显降低趋势,SOD活性相比于对照组均居于明显增强趋势(P<0.05)。观察组POD发生率相比于对照组明显大幅减少(P<0.05)。结论:老年髋部骨折患者予以采取H_(2)吸入方案,可有效预防和减少POD的发生。

Objective To explore the clinical advantages of H_(2) inhalation in the treatment of delirium(POD)after hip fracture in elderly patients.Method 80 elderly patients with hip fracture were treated in our hospital from December 2020 to June 2021.They were divided into two groups according to the difference of treatment scheme.40 patients were included in the control group(33%O_(2) inhalation scheme.Arterial blood gas was measured 0.5 h before H_(2) inhalation),and 40 patients were included in the observation group(67%H_(2)+33%O_(2) mixed gas was inhaled for 1H at each time point before anesthesia and immediately after operation),before H_(2) inhalation before operation and on the first day after H_(2) inhalation.The arterial blood was collected at different time points such as the third day,and the activity indexes of interleukin-6(IL-6)and superoxide dismutase(SOD)were observed and evaluated.The occurrence of POD 7 days after operation was evaluated and compared between the two groups.Results the blood gas indexes of pH,PaO_(2) and PaCO_(2) were evaluated before and after 0.5 h of H_(2) inhalation in the two groups,and there was no significant change(P>0.05).The IL-6 levels of the two groups were significantly higher than those before the first day and the third day after the inhalation of H_(2),and the activity of s0d was significantly decreased compared with that before the operation(P<0.05).The IL-6 concentration in observation group was significantly lower than that in control group on the first day after inhalation of H_(2) and at different time points at the third day,and SOD activity was significantly increased compared with that in control group(P<0.05).The incidence of pod in observation group was significantly lower than that of the control group(P<0.05).Conclusion the H_(2) inhalation scheme can effectively prevent and reduce the occurrence of pod in the elderly patients with hip fracture.