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阿托伐他汀治疗对老年恶性肿瘤手术后谵妄的影响

Effects of Atorvastatin Therapy on Postoperative Delirium After Malignant Tumor Surgeries in Older Adults.

作者信息

Wan Rong, Cai Shengwei, Pan Dejian, Yang Weilin, Zhou Rengui

机构信息

Department of Quality Management, The 904th Hospital of Joint Logistic Support Force (Anhui Medical University Affiliated Wuxi Clinical College), Wuxi, 214044, People's Republic of China.

Department of Oncology, The 904th Hospital of Joint Logistic Support Force (Anhui Medical University Affiliated Wuxi Clinical College), Wuxi, 214044, People's Republic of China.

出版信息

Neuropsychiatr Dis Treat. 2022 Apr 19;18:915-923. doi: 10.2147/NDT.S360332. eCollection 2022.

Abstract

INTRODUCTION

Postoperative delirium (POD) is one of the prevalent and potentially fatal clinical conditions, leading to high disability and mortality in older patients, as well as increased duration of hospital stay and more hospitalization expenses. There were no effective drugs in the clinical management of POD, and an absence of evidence-based medicine concerning the treatment of POD.

MATERIALS AND METHODS

The present study explored whether atorvastatin (Ato) can decrease the occurrence rate of POD. The present research included patients over the age of 60 who were hospitalized to critical care units (ICUs) following surgery for malignant tumors. Patients received Ato (40mg/day) or placebos utilizing a computer-based random sequencing (in a 1:1 ratio). The primary outcome measure was the occurrence of delirium within the first seven days following surgery.

RESULTS

A total of 230 individuals were classified into two groups, namely the placebo group (n=123) and the Ato group (n=107). Patients belonging to two groups had similar baseline clinical data, and there were no statistically significant differences between them. The occurrence of delirium in the Ato group was remarkably reduced unlike the case in the placebo group. 30-day all-cause mortality did not vary significantly between the two groups. Pulmonary infection and Bedsore were significantly decreased in the Ato group than the placebo group, there were no statistically significant differences between the two groups in rhabdomyolysis and abnormal liver enzymes. In terms of medication responses, there were no statistically significant differences between the two groups. Ato patients had remarkably shortened hospital stays and spent remarkably less on hospitalization expenditures in comparison with those in the placebo group.

CONCLUSION

The findings from the present research indicated that Ato can decrease the occurrence of delirium following surgical operation of malignant tumors among elderly patients, it also can reduce the duration of hospitalization, hospital cost, and post-surgical complications, but not improve 30-day all-cause mortality.

REGISTRATION NUMBER

ChiCTR-IPR-17011984.

摘要

引言

术后谵妄(POD)是一种常见且可能致命的临床病症,会导致老年患者出现高致残率和死亡率,还会延长住院时间并增加住院费用。在POD的临床管理中没有有效的药物,且缺乏关于POD治疗的循证医学依据。

材料与方法

本研究探讨阿托伐他汀(Ato)是否能降低POD的发生率。本研究纳入了60岁以上因恶性肿瘤手术后入住重症监护病房(ICU)的患者。患者通过计算机随机序列接受Ato(40mg/天)或安慰剂(比例为1:1)。主要观察指标是术后前七天内谵妄的发生情况。

结果

总共230人被分为两组,即安慰剂组(n = 123)和Ato组(n = 107)。两组患者的基线临床数据相似,且两组之间无统计学显著差异。与安慰剂组不同,Ato组谵妄的发生率显著降低。两组之间30天全因死亡率无显著差异。Ato组的肺部感染和褥疮比安慰剂组显著减少,两组在横纹肌溶解和肝酶异常方面无统计学显著差异。在药物反应方面,两组之间无统计学显著差异。与安慰剂组相比,Ato组患者的住院时间显著缩短,住院费用显著降低。

结论

本研究结果表明,Ato可降低老年患者恶性肿瘤手术后谵妄的发生率,还可缩短住院时间、降低住院费用和减少术后并发症,但不能改善30天全因死亡率。

注册号

ChiCTR - IPR - 17011984。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09d0/9034858/30fba0b2c318/NDT-18-915-g0001.jpg

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