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| 听觉环境对全身麻醉下全膝关节置换术老年患者术后谵妄的影响 |
| Effect of auditory environment on postoperative delirium in elderly patients undergoing total knee arthroplasty under general anesthesia |
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| DOI：10.12089/jca.2026.08.004 |
| 中文关键词: 全身麻醉 全膝关节置换术 听觉环境 术后谵妄 音乐疗法 噪声 |
| 英文关键词: General anesthesia Total knee arthroplasty Auditory environment Postoperative delirium Music therapy Noise |
| 基金项目:山西医科大学第一医院院基金（YQ2210） |
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| 中文摘要: |
目的： 探讨术中不同听觉环境干预对全身麻醉下行全膝关节置换术（TKA）的老年患者术后谵妄（POD）的影响。
方法： 选择2024年5月至2025年5月择期全身麻醉下行TKA的老年患者，年龄65～84岁，BMI 18.5～28.0 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为三组：对照组、音乐组和降噪组。对照组术中暴露于常规手术室环境，音乐组术中通过降噪耳机聆听校准至40～60 dB的纯音乐，降噪组术中佩戴主动降噪耳机以隔离环境噪声。主要指标为术后3 d内POD发生率。次要指标包括术后24 h静息和活动时NRS评分，入室时、手术开始时、手术开始后30 min、手术结束时HR、MAP、BIS、局部脑氧饱和度（rScO2），麻醉药物用量、手术时间、PACU停留时间和补救镇痛率。不良反应包括头晕、低血压和恶心呕吐。
结果： 共纳入患者120例，每组40例。三组术后3 d内POD发生率差异无统计学意义。与对照组比较，音乐组和降噪组术后24 h静息、活动时NRS疼痛评分明显降低，补救镇痛率明显降低（P<0.05）。与音乐组比较，降噪组术后24 h活动时NRS评分明显降低（P<0.05）。三组头晕、低血压和恶心呕吐发生率差异无统计学意义。
结论： 对于行TKA的老年患者，术中听觉环境对POD发生率无统计学差异，但术中听觉环境的干预可显著减轻老年患者术后静息及活动时疼痛，且降噪在缓解活动时疼痛方面优于音乐干预。 |
| 英文摘要: |
Objective: To investigate the impact of different intraoperative auditory environment interventions on the incidence of postoperative delirium (POD) in elderly patients undergoing total knee arthroplasty (TKA) under general anesthesia.
Methods: Elderly patients aged 65-84 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅱ or Ⅲ, scheduled for elective TKA under general anesthesia from May 2024 to May 2025, were randomly assigned to three groups: the control group, the music group, and the noise-canceling group. The control group were exposed to a conventional operating room acoustic environment, the music group listened to pure music calibrated to 40-60 dB via noise-canceling headphones, and the noise-canceling group wore active noise-canceling headphones without music to attenuate ambient noise. The primary outcome was the incidence of POD within 3 days postoperatively. Secondary outcomes included NRS scores at rest and during movement at 24 hours after surgery, HR, MAP, BIS, and regional cerebral oxygen saturation (rScO2) at entering the operating room, at the start of the surgery, 30 minutes after surgery begins, and at the end of the surgery, anesthetic consumption, operative time, postanesthesia care unit (PACU) stay time, and incidence of rescue analgesia. Adverse events included dizziness, hypotension, and nausea and vomiting.
Results: A total of 120 elderly patients were analyzed, 40 patients in each group. There were no significantly differences in the incidence of POD within 72 hours postoperatively among the three groups. Compared with the control group, NRS scores at rest and during movement at 24 hours after surgery and the incidence of rescue analgesia were significantly decreased in the music group and the noise-canceling group (P < 0.05). Compared with the music group, NRS scores during movement at 24 hours after surgery was significantly decreased in the noise-canceling group (P < 0.05). There were no significantly differences in the incidence of dizziness, hypotension, and nausea and vomiting among the three groups.
Conclusion: In elderly patients undergoing TKA, there were no statistically significant effect of intraoperative auditory intervention on the incidence of POD. Intraoperative auditory intervention significantly alleviates both resting and movement evoked postoperative pain, and active noise cancellation is superior to music intervention in reducing movement related pain. |
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