【原】【周五】经典高分文献阅读·术前使用咪达唑仑与术后早期谵妄无关

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Midazolam Premedication Immediately Before Surgery Is Not Associated With Early Postoperative Delirium

术前短期使用咪达唑仑与术后早期谵妄无关

背景

BACKGROUND: Postoperative delirium is common among older surgical patients and may be associated with anesthetic management during the perioperative period. The aim of this study is to assess whether intravenous midazolam, a short-acting benzodiazepine used frequently as premedication, increased the incidence of postoperative delirium.

术后谵妄在老年外科患者中很常见，可能与围手术期麻醉管理有关。本研究的目的是评估静脉注射咪达唑仑是否增加了术后谵妄的发生率，咪达唑仑是一种短效的苯二氮卓类药物，经常作为术前用药。

方法

METHODS: Analyses of existing data were conducted using a database created from 3 prospective studies in patients aged 65 years or older who underwent elective major noncardiac

surgery. Postoperative delirium occurring on the first postoperative day was measured using the confusion assessment method. We assessed the association between the use or nonuse of premedication with midazolam and postoperative delirium using a χ2 test, using propensity scores to match up with 3 midazolam patients for each control patient who did not receive midazolam.

使用3项前瞻性研究建立的数据库对现有数据进行分析，这些被研究的患者年龄在65岁或以上，接受了择期大型非心脏手术。术后第一天出现谵妄的情况采用混淆评估法进行测量。我们使用χ2检验评估了术前使用或不使用咪达唑仑与术后谵妄之间的关系，使用倾向评分把每个对照组中未使用咪达唑仑的患者和3例使用咪达唑的仑患者做对比。

Table&Figure

患者特征

倾向评分匹配

结果

RESULTS: A total of 1266 patients were included in this study. Intravenous midazolam was administered as premedication in 909 patients (72%), and 357 patients did not receive midazolam. Those who did and did not receive midazolam significantly differed in age, Charlson comorbidity scores, preoperative cognitive status, preoperative use of benzodiazepines, type of surgery, and year of surgery. Propensity score matching for these variables and American Society of Anesthesiology physical status scores resulted in propensity score–matched samples with 1–3 patients who used midazolam (N = 749) for each patient who did not receive midazolam (N = 357). After propensity score matching, all standardized differences in preoperative patient characteristics ranged from –0.07 to 0.06, indicating good balance on baseline variables between the 2 exposure groups. No association was found between premedication with midazolam and incident delirium on the morning of the first postoperative day in the matched dataset, with odds ratio

(95% confidence interval) of 0.91 (0.65-1.29), P = .67.

本研究共纳入1266例患者。其中909例(72%)患者在术前静脉注射咪达唑仑，357例患者未注射咪达唑仑。接受和未接受咪达唑仑的患者在年龄、Charlson疾病评分、术前认知状况、术前使用苯二氮卓类药物、手术类型和手术年份上有显著差异，所以采用倾向评分匹配。在倾向评分匹配的样本中，每1例未使用咪达唑仑(N = 357)的患者，匹配1-3例使用咪达唑仑(N = 749)的患者。倾向评分匹配后，术前患者特征的所有标准差均在-0.07到0.06之间，表明两组暴露组之间的基线变量具有良好的平衡。匹配的数据集显示，术前给与咪达唑仑给与术后第一天早上发生谵妄之间不存在关联（优势比0.91; 95%CI : 0.65-1.2 ; P= 0.67）

结论

CONCLUSIONS: Premedication using midazolam was not associated with higher incidence of delirium on the first postoperative day in older patients undergoing major noncardiac surgery.

在接受大型非心脏手术的老年患者中，术前使用咪达唑仑与术后第一天谵妄发生率增高无关。