高压氧治疗对膝关节置换术患者术后谵妄的影响及其影响因素分析

Influence of hyperbaric oxygen therapy on postoperative delirium after knee replacement and analysis of risk factors

目的探讨高压氧治疗对膝关节置换术患者术后谵妄的影响及其影响因素。方法选取2020年1月至2022年12月于商丘市第一人民医院接受膝关节置换术的患者96例作为研究对象,依据随机数字表法将其分为对照组和观察组,每组48例。2组患者均在全麻情况下接受膝关节置换术,且在缝皮时接受膝关节鸡尾酒局部镇痛结合术后镇痛泵镇痛,观察组在此基础上在术前1 d、术后1~3 d接受高压氧治疗。比较2组患者不同时点的平均动脉压(MAP)、心率(HR)和谵妄发生率。根据谵妄发生情况,将患者分为发生组和未发生组,比较2组患者的性别、年龄、合并疾病等一般资料,采用二元Logistics回归分析术后谵妄的影响因素。结果对照组和观察组患者不同时点的MAP、HR比较差异无统计学意义(P>0.05)。观察组患者术后7 d的谵妄总发生率(5/49,10.42%)明显低于对照组(13/49,27.08%),差异有统计学意义(χ^(2)=4.376,P=0.036)。与未发生组比较,发生组患者年龄更大,美国麻醉医师协会(ASA)分级Ⅱ级、Ⅲ级占比更多,差异有统计学意义(P<0.05)。结论高压氧可降低膝关节置换术患者术后谵妄发生率,年龄、ASA分级是影响膝关节置换术患者术后谵妄发生的因素。

Objective To analyze the effect of hyperbaric oxygen therapy on the incidence of postoperative delirium after knee replacement and the related risk factors.Methods A total of 96 patients who received knee replacement in the First People’s Hospital of Shangqiu from January 2020 to December 2022 were selected as the study objects.They were divided into control group and observation group according to the random number table method,with 48 cases in each group.Patients in both groups received knee replacement under general anesthesia,and knee joint cocktail local analgesia combined with postoperative analgesia pump during skin suture.The observation group received hyperbaric oxygen therapy 1 day before surgery and day 1–3 after surgery on the basis of the treatments of the control group.The mean arterial pressure(MAP),heart rate(HR),and incidence of delirium were compared between 2 groups at different time points.According to the occurrence of delirium,the patients were divided into the occurrence group and the non-occurrence group.The gender,age,combined diseases,and other relevant data of the two groups were compared,and the factors affecting postoperative delirium were analyzed by binary logistics regression.Results There was no significant difference in MAP or HR between control group and observation group at different time points(P>0.05).The total incidence of delirium on day 7 after surgery in the observation group(5/49,10.42%)was lower than that in the control group(13/49,27.08%),and the difference was statistically significant(χ^(2)=4.376,P=0.036).Compared with the non-occurrence group,the patients in the occurrence group were older,and the proportion of the patients with American Society of Anesthesiologists(ASA)grade II or III was higher,with statistically significant differences(P<0.05).Conclusion Hyperbaric oxygen therapy can reduce the incidence of postoperative delirium after knee replacement.Age and ASA grade are the factors affecting the occurrence of postoperative delirium after knee replacement.