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1.

Introduction

There are no previous studies evaluating the effect of intravenous iron therapy on functional and cognitive status of patients with hip fracture (HF).

Material and methods

A single-centre randomised, placebo-controlled, double-blind and parallel treatment, clinical trial has been designed to assess the efficacy of intravenous iron therapy during the peri-operative period in elderly patients suffering from a HF. Blinding will be ensured by the packaging of the drug infusion system. On days 1, 3, and 5 from admission, the intervention group will receive 200 mg Venofer® (iron sucrose) diluted in 100 ml saline, and the control group 100 ml saline, also on days 1, 3 and 5. Patients will received conventional treatment in ortho-geriatric unit of the Hospital Infanta Sofia. Functional variables (activities of daily living and walking), cognitive (cognitive status and delirium), surgical, demographic and clinical characteristics will be collected during admission in order to assess the impact of treatment. A safety analysis of the treatment will also performed. Patients will be followed-up at 3, 6, and 12 months.

Results

The study will attempt to provide evidence on the impact of the intravenous iron administration on functional recovery. It will be determined whether iron therapy negatively affects the incidence of post-operative delirium. Finally, report will be presented on the safety data of intravenous iron in elderly HF patients, as well as the impact on allogenic blood transfusion savings.

Conclusions

The inclusion of elderly HF patients admitted to an ortho-geriatric unit, in a clinical trial, will help to improve the knowledge of the treatment impact on a usual scenario, and provide useful data for use in other units.  相似文献   
2.
摘要 目的:探讨不同剂量右美托咪定辅助麻醉对老年结肠癌根治术患者麻醉效果,并分析术后谵妄的影响因素。方法:选取2019年4月~2021年1月期间我院收治的160例老年结肠癌根治术患者,根据随机数字表法将患者分为A组(53例)、B组(53例)和C组(54例)。A组和B组均于麻醉诱导前给予0.5 μg/kg右美托咪定,以0.2 μg/kg?h速率静脉输注至手术结束前30 min,A组术后镇痛时再给予右美托咪定0.05 μg/kg?h。C组给予等容量和等速率的生理盐水。观察三组的应激反应、麻醉效果、不良反应发生率、谵妄发生率。根据是否发生谵妄分为谵妄组(n=28)和无谵妄组(n=132)。采用Logistic回归分析术后谵妄的影响因素。结果:三组术后第3 d C反应蛋白(CRP)、白介素-6(IL-6)、多巴胺、肾上腺素均较手术结束升高(P<0.05)。A组、B组术后第3 d CRP、IL-6、多巴胺、肾上腺素低于C组(P<0.05)。A组、B组术后第3dCRP、IL-6、多巴胺、肾上腺素组间对比,无明显差异(P>0.05)。A组、B组、C组的不良反应总发生率组间的对比无明显差异(P>0.05)。B组的谵妄发生率明显低于A组、C组(P<0.05)。A组、C组谵妄发生率组间对比无明显差异(P>0.05)。单因素分析结果显示,术后谵妄的发生与年龄、术前抑郁、术前合并基础疾病数量、术中低氧血症、气腹后PaCO2、白蛋白有关(P<0.05)。多因素Logistic回归分析结果显示:术前抑郁、年龄≥70岁、术前合并基础疾病数量≥3、术中低氧血症、气腹后PaCO2偏高、白蛋白偏低是导致老年结肠癌根治术患者术后谵妄的危险因素(P<0.05)。结论:小剂量右美托咪定辅助麻醉可提高老年结肠癌根治术患者的麻醉效果,减少谵妄的发生率,同时术前抑郁、年龄≥70岁、术前合并基础疾病数量≥3、术中低氧血症、气腹后PaCO2偏高、白蛋白偏低是引起谵妄发生的危险因素。  相似文献   
3.
目的:探讨右美托咪定和丙泊酚对髋部骨折手术患者术后镇静效果及谵妄改善效果的影响。方法:选取2016年4月-2018年3月于我院行髋部骨折手术的108例患者作为研究对象,按随机数字表法分为观察组(n=54)和对照组(n=54),两组患者术中均采用全身静脉麻醉,观察组患者给予右美托咪定进行镇静诱导,对照组患者给予丙泊酚进行镇静诱导。术后24h,采用Ramsay镇静评分评价两组患者术后的镇静效果,采用视觉模拟量表(VAS)评分评价术后镇痛效果,术后1周,对两组患者术后谵妄发生率、谵妄评定量表(CAM)评分、简易智能精神状态检查量表(MMSE)评分进行比较,记录不良反应发生情况。结果:术后24h,观察组患者的Ramsay镇静评分高于对照组,VAS评分及镇痛药追加量低于对照组,差异有统计学意义(P0.05)。术后1周,观察组患者谵妄发生率、CAM评分低于对照组,MMSE评分高于对照组,差异有统计意义(P0.05)。观察组不良反应发生率为9.26%,与对照组的14.81%比较,差异无统计学意义(P0.05)。结论:与丙泊酚相比,髋部骨折手术患者应用右美托咪定可获得更好的术后镇静、镇痛效果,能够降低谵妄的发生率,且无严重不良反应发生,有较高的临床应用价值。  相似文献   
4.
摘要 目的:探讨术前糖化血红蛋白(HbAlc)水平与老年髋关节置换术后谵妄的关系,并分析术后发生谵妄的影响因素。方法:选择我院于2019年4月~2020年6月期间收治的行髋关节置换术的220例老年患者作为研究对象。收集患者临床资料,记录其术后发生谵妄情况。采用单因素及多因素Logistic回归分析术后发生谵妄的影响因素。采用Pearson相关分析评估患者术前HbAlc水平与术后意识障碍评估量表(CAM)评分的相关性。结果:220例患者根据剔除标准剔除20例,最终200例老年髋关节置换术后患者出现谵妄42例,发生率为21.00%(42/200)。将发生谵妄的患者纳为谵妄组(n=42),未发生谵妄的患者纳为非谵妄组(n=158)。谵妄组的术前HbAlc水平、术后CAM评分均高于非谵妄组(P<0.05)。Pearson相关分析显示,患者术前HbAlc水平与术后CAM评分呈正相关(P<0.05)。单因素分析结果显示,老年髋关节置换术后发生谵妄与年龄、术前合并呼吸系统性疾病、手术时间、发生低氧血症、术后疼痛评分、存在电解质紊乱有关(P<0.05),多因素Logistic回归分析结果显示,年龄>80岁、发生低氧血症、术后疼痛评分>3分、术前HbAlc水平>8%均是老年髋关节置换术后发生谵妄的危险因素(P<0.05)。结论:高龄、术前HbAlc水平较高的患者是髋关节置换术后发生谵妄的高危人群,且围术期应尽量给予减少疼痛、预防术后低氧血症的措施,以降低术后谵妄的发生风险。  相似文献   
5.
目的:探讨右美托咪啶对急性主动脉夹层患者谵妄及血清C反应蛋白(CRP)、基质金属蛋白酶(MMPs)、N端前脑钠肽(NT-proBNP)、中性粒细胞弹性蛋白酶(NE)水平的影响。方法:选择2014年1月~2017年1月我院收治的急性主动脉夹层患者84例,根据随机数字表法将其分为对照组(n=42)与研究组(n=42)。对照组入院后给予吗啡镇痛,研究组则给予右美托咪啶镇痛。观察对比两组治疗前与治疗24 h后C反应蛋白(CRP)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶-2(MMP-2)、NT-proBNP和NE水平、谵妄的发生率以及脱机持续时间与ICU入住时间。结果:治疗前两组患者CRP、MMP-9、MMP-2、NT-proBNP、NE水平比较无统计学差异(P0.05),治疗24h后研究组CRP、MMP-9、MMP-2、NT-proBNP、NE水平低于对照组与治疗前,差异有统计学意义(P0.05)。研究组术后谵妄的发生率为7.14%(3/42),低于对照组的26.19%(11/42),差异有统计学意义(P0.05)。研究组脱机持续时间与ICU入住时间均低于对照组,差异有统计学意义(P0.05)。结论:右美托咪啶不仅具有镇痛、镇静等效应,还对急性主动脉夹层患者炎性反应具有显著的抑制作用,且降低了谵妄的发生率,保证了患者的预后质量。  相似文献   
6.
BackgroundThe aim of this paper is to describe the prevalence of Delirium and the factors associated with its presentation and complications identified in a geriatric unit in Colombia.Material and methodsThis is a retrospective observational study that included all patients admitted consecutively for two years in a geriatric unit of a hospital in Bogotá, Colombia. We assessed delirium prevalence with the Confusion Assessment Method (CAM). The independent variables were age, sex, functional impairment (Barthel < 90), malnutrition (MNA < 12), pressure ulcers at admission, state of the social support network, number of comorbidities, polypharmacy (5 or more drugs), complications such as ICU requirement, hospital stay, in-hospital functional impairment and mortality were also evaluated. As an exclusion criterion: not having CAM registered in the medical record, all the patients had this information.ResultsWe studied 1599 subjects with a mean age of 86 years (IQR 9). Delirium prevalence was 51.03%. Delirium was associated with a higher rate of: pressure ulcers on admission [OR 3.76 (CI 2.60–5.43 p < 0.001)], functional impairment [OR 2.38 (CI 1.79–3.16 p < 0.001)], malnutrition [OR 2.06 (CI 1.56–2.73 p < 0.001)], and infection [OR 1.46 (CI 1.17–1.82 p < 0.001)]. Moreover delirium has a higher association with mortality [OR 2.80 (1.03–7.54 p = 0.042)], in-hospital functional decline [OR 1.82 (1.41–2.36 p < 0.001)], and longer hospital stay [OR 1.04 (1.04–1.09 p = 0.006)]; independently of age, sex, pressure ulcers on admission, functional impairment, malnutrition, dementia, infection and limited social network.ConclusionOur study suggests that infectious diseases and geriatric syndromes such as, functional dependence, pressure ulcers, malnutrition or major cognitive impairment are independently associated with the presence of delirium on admission. Additionally, the presence of delirium is independently associated during hospitalization with complications, longer hospital stay, functional impairment and mortality.  相似文献   
7.

Introduction

The aim of this study was to analyse the effect of cognitive impairment on functional decline in hospitalised patients aged ≥ 60 years.

Methods

Measurements at admission included demographic data, Charlson's comorbidity index, and cognitive impairment (according to education level).Data were also collected on hospital length of stay, depression, and delirium developed during hospitalisation. The outcome, Barthel Index (BI), was measured at admission, discharge, and 1-month post-discharge. Patients with BI  75 at admission (n = 54) or with a missing BI value were excluded (n = 1). Multivariate logistic regression analyses were conducted to explore predictive factors with functional decline (BI  75) from admission to discharge, and 1-month later.

Results

Of the 133 patients included, 24.8% and 19.6% had a BI  75 at discharge and at 1-month, respectively. Compared with men, women had more than double risk for functional decline at discharge and 1-month (P < .05). Compared with those without delirium and without cognitive impairment, those with delirium and cognitive impairment had an increased risk for functional decline (BI  75) at discharge (OR 5.15, 95% CI; 1.94-13.67), and at 1-month (OR 6.26, 95% CI; 2.30-17.03). Similarly, those with comorbidity (≥ 2) had increased functional decline at discharge (OR 2.36, 95% CI; 1.14-4.87), and at 1-month after discharge (OR 2.71, 95% CI; 1.25-5.89).

Conclusion

Delirium during hospitalisation, together with cognitive impairment on admission, was a strong predictor of functional decline.  相似文献   
8.
摘要 目的:探讨右美托咪定联合罗哌卡因腹横肌平面阻滞(TAPB)对老年腹腔镜胃癌根治术患者炎症反应、应激反应及术后谵妄的影响。方法:选择2017年7月~2019年10月期间我院接收的行腹腔镜胃癌根治术的老年患者118例,按随机信封抽签法将其分为A组(n=59,罗哌卡因TAPB麻醉)和B组(n=59,右美托咪定联合罗哌卡因TAPB麻醉),对比两组血流动力学指标、应激反应、炎症反应、术后疼痛、术后谵妄及不良反应发生率。结果:两组TAPB阻滞即刻(T1)~拔管时(T4)时间点心率(HR)、平均动脉压(MAP)均较麻醉前(T0)时间点升高(P<0.05),B组T1~T4时间点HR、MAP低于A组(P<0.05)。两组术后3 d、术后5 d皮质醇(Cor)、去甲肾上腺素(NE)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平高于术前,但术后5 d 低于术后3 d(P<0.05),B组术后3 d、术后5 d的IL-6、TNF-α、Cor、NE水平低于A组(P<0.05)。B组的术后谵妄发生率较A组降低(P<0.05),两组不良反应发生率对比无差异(P>0.05)。B组术后6 h、术后12 h、术后24 h、术后48 h视觉模拟评分法(VAS)评分低于A组(P<0.05)。结论:老年腹腔镜胃癌根治术患者采用右美托咪定联合罗哌卡因TAPB可维持血流动力学稳定,减轻应激反应、炎症反应,降低术后谵妄发生率,术后镇痛效果良好,且安全性较好。  相似文献   
9.

Introduction

Subsyndromal delirium (SSD) is a developing concept of disease with a spectrum beyond the diagnostic dichotomy of delirium with standard criteria.

Material and methods

To study the prevalence and significance of SSD we have conducted a cross-sectional prospective multicenter study of all patients admitted to three Geriatric Departments in tertiary hospitals. The SSD diagnostic criteria used were based on Marcantoniós criteria, and the DRS-R-98 scale was also used as a continuous variable of the degree of delirium.

Results

We studied 85 patients, 56% women, Barthel 62 (SD: 32), age 87 (SD: 6), CIRS-G 24 (SD: 6.85). Three quarters (75.3%) of patients had at least one CAM positive item, and half of them with at least 13 points in the DRS-R-98 scale. The prevalence of delirium was 53% and 22.3% for SSD. The degree of delirium-DSS was associated with different geriatric syndromes, levels of malnutrition, and degree of functional and cognitive impairment, with a significant linear trend between groups. Patients without delirium have higher levels than those with subsyndromal delirium, and these in turn are higher than those without diagnosed delirium. There is also a tendency in the degree of delirium measured by the DRS-R-98.

Conclusion

Beyond the dichotomous concept of the presence or absence of delirium, this study suggests the probable continuity of cognitive processes and the possibility of more effective and earlier diagnostic and therapeutic measures  相似文献   
10.
Copeptin can reflect individual's stress state and are correlated with poor outcome of critical illness. The occurrence of postoperative delirium (POD) and cognitive dysfunction (POCD) is associated with worse outcome after coronary artery bypass graft (CABG) surgery. The present study aimed to investigate the ability of postoperative plasma copeptin level to predict POD and POCD in patients undergoing CABG surgery. Postoperative plasma copeptin levels of 108 patients were measured by an enzyme-linked immunosorbent assay. It was demonstrated that plasma copeptin levels were substantially higher in patients with POD than without POD (1.8 ± 0.6 ng/mL vs. 1.1 ± 0.3 ng/mL; P < 0.001) and in patients with POCD than without POCD (1.9 ± 0.6 ng/mL vs. 1.1 ± 0.4 ng/mL; P < 0.001). Plasma copeptin level and age were identified as independent predictors for POD [odds ratio (OR), 67.386; 95% confidence interval (CI), 12.031–377.426; P < 0.001 and OR, 1.202; 95% CI, 1.075–1.345; P = 0.001] and POCD (OR, 28.814; 95% CI, 7.131–116.425; P < 0.001 and OR, 1.151; 95% CI, 1.030–1.285; P = 0.003) using a multivariate analysis. For prediction of POD, the area under receiver operating characteristic curve (AUC) of the copeptin concentration (AUC, 0.883; 95% CI, 0.807–0.937) was markedly higher than that of age (AUC, 0.746; 95% CI, 0.653–0.825; P = 0.020). For prediction of POCD, the AUC of the copeptin concentration (AUC, 0.870; 95% CI, 0.792–0.927) was markedly higher than that of age (AUC, 0.735; 95% CI, 0.641–0.815; P = 0.043). Thus, postoperative plasma copeptin level may be a useful, complementary tool to predict POD and POCD in patients undergoing CABG surgery.  相似文献   
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