PDF(Pubmed)
Abstract：
BACKGROUND: Postoperative delirium (POD) often occurs in oncology patients, further increasing the medical and financial burden. Robotic technology in lower abdominal tumors resection reduces surgical trauma but increases risks such as carbon dioxide (CO2) absorption. This study aimed to investigate the differences in their occurrence of POD at different end-tidal CO2 levels.
METHODS: This study was approved by the Ethics Committee of Affiliated Hospital of He Bei University (HDFY-LL-2022-169). The study was registered with the Chinese Clinical Trials Registry on URL: http://www.chictr.org.cn , Registry Number: ChiCTR2200056019 (Registry Date: 27/08/2022). In patients scheduled robotic lower abdominal tumor resection from September 1, 2022 to December 31, 2022, a comprehensive delirium assessment was performed three days postoperatively using the CAM scale with clinical review records. Intraoperative administration of different etCO2 was performed depending on the randomized grouping after intubation. Group L received lower level etCO2 management (31-40mmHg), and Group H maintained the higher level(41-50mmHg) during pneumoperitoneum. Data were analyzed using Pearson Chi-Square or Wilcoxon Rank Sum tests and multiple logistic regression. Preoperative mental status score, alcohol impairment score, nicotine dependence score, history of hypertension and diabetes, duration of surgery and worst pain score were included in the regression model along with basic patient information for covariate correction analysis.
RESULTS: Among the 103 enrolled patients, 19 (18.4%) developed postoperative delirium. The incidence of delirium in different etCO2 groups was 21.6% in Group L and 15.4% in Group H, respectively, with no statistical differences. In adjusted multivariate analysis, age and during of surgery were statistically significant predictors of postoperative delirium. The breath-hold test was significantly lower postoperatively, but no statistical differences were found between two groups.
CONCLUSIONS: With robotic assistant, the incidence of postoperative delirium in patients undergoing lower abdominal tumor resection was not modified by different end-tidal carbon dioxide management, however, age and duration of surgery were positively associated risk factors.
METHODS: This study was approved by the Ethics Committee of Affiliated Hospital of He Bei University (HDFY-LL-2022-169). The study was registered with the Chinese Clinical Trials Registry on URL: http://www.chictr.org.cn , Registry Number: ChiCTR2200056019 (Registry Date: 27/08/2022). In patients scheduled robotic lower abdominal tumor resection from September 1, 2022 to December 31, 2022, a comprehensive delirium assessment was performed three days postoperatively using the CAM scale with clinical review records. Intraoperative administration of different etCO2 was performed depending on the randomized grouping after intubation. Group L received lower level etCO2 management (31-40mmHg), and Group H maintained the higher level(41-50mmHg) during pneumoperitoneum. Data were analyzed using Pearson Chi-Square or Wilcoxon Rank Sum tests and multiple logistic regression. Preoperative mental status score, alcohol impairment score, nicotine dependence score, history of hypertension and diabetes, duration of surgery and worst pain score were included in the regression model along with basic patient information for covariate correction analysis.
RESULTS: Among the 103 enrolled patients, 19 (18.4%) developed postoperative delirium. The incidence of delirium in different etCO2 groups was 21.6% in Group L and 15.4% in Group H, respectively, with no statistical differences. In adjusted multivariate analysis, age and during of surgery were statistically significant predictors of postoperative delirium. The breath-hold test was significantly lower postoperatively, but no statistical differences were found between two groups.
CONCLUSIONS: With robotic assistant, the incidence of postoperative delirium in patients undergoing lower abdominal tumor resection was not modified by different end-tidal carbon dioxide management, however, age and duration of surgery were positively associated risk factors.
摘要：
背景：肿瘤患者常发生术后谵妄（POD），进一步加重了医疗和经济负担。下腹部肿瘤切除术中的机器人技术减少了手术创伤，但增加了二氧化碳（CO2）吸收等风险。本研究旨在调查不同潮气末CO2水平下POD发生的差异。
方法：本研究经河北大学附属医院伦理委员会批准（HDFY-LL-2022-169）。该研究在中国临床试验注册中心注册，网址为：http://www。chictr.org.cn,登记号：ChiCTR2200056019（登记日期：2022年8月27日）。在2022年9月1日至2022年12月31日计划进行机器人下腹部肿瘤切除术的患者中，术后三天使用带有临床回顾记录的CAM量表进行全面的谵妄评估。根据插管后的随机分组，术中给予不同的etCO2。L组接受了较低水平的二氧化碳管理（31-40mmHg），H组在气腹期间维持较高水平（41-50mmHg）。使用Pearson卡方或Wilcoxon秩和检验和多元逻辑回归分析数据。术前精神状态评分,酒精损伤评分,尼古丁依赖评分，高血压和糖尿病史，手术时间和最差疼痛评分与基本患者信息一起纳入回归模型,用于协变量校正分析.
结果：在103名患者中，19人（18.4%）发生术后谵妄。不同ETCO2组谵妄发生率L组为21.6%,H组为15.4%,分别,没有统计学差异。在调整后的多变量分析中，年龄和手术期间是术后谵妄的统计学显著预测因素.屏气试验在术后显著降低,但两组间无统计学差异。
结论：使用机器人助手，不同的呼气末二氧化碳管理不能改善下腹部肿瘤切除术患者术后谵妄的发生率，然而,年龄和手术时间是正相关的危险因素.
方法：本研究经河北大学附属医院伦理委员会批准（HDFY-LL-2022-169）。该研究在中国临床试验注册中心注册，网址为：http://www。chictr.org.cn,登记号：ChiCTR2200056019（登记日期：2022年8月27日）。在2022年9月1日至2022年12月31日计划进行机器人下腹部肿瘤切除术的患者中，术后三天使用带有临床回顾记录的CAM量表进行全面的谵妄评估。根据插管后的随机分组，术中给予不同的etCO2。L组接受了较低水平的二氧化碳管理（31-40mmHg），H组在气腹期间维持较高水平（41-50mmHg）。使用Pearson卡方或Wilcoxon秩和检验和多元逻辑回归分析数据。术前精神状态评分,酒精损伤评分,尼古丁依赖评分，高血压和糖尿病史，手术时间和最差疼痛评分与基本患者信息一起纳入回归模型,用于协变量校正分析.
结果：在103名患者中，19人（18.4%）发生术后谵妄。不同ETCO2组谵妄发生率L组为21.6%,H组为15.4%,分别,没有统计学差异。在调整后的多变量分析中，年龄和手术期间是术后谵妄的统计学显著预测因素.屏气试验在术后显著降低,但两组间无统计学差异。
结论：使用机器人助手，不同的呼气末二氧化碳管理不能改善下腹部肿瘤切除术患者术后谵妄的发生率，然而,年龄和手术时间是正相关的危险因素.
