术前口服碳水化合物对老年患者术后谵妄影响的研究进展
Advances in Research on the Impact of Preoperative Oral Carbohydrates on Postoperative Delirium in Elderly Patients
摘要: 随着人口老龄化，选择进行外科手术的老年患者逐渐增加，但由于老年人自身生理变化、术前营养不良及术前长时间禁食等原因，使老年患者术后谵妄发生率升高。术前碳水化合物作为快速康复外科学(ERAS)范式的当代要素，作用于预防术后谵妄的发生成为了临床上的研究热点。充分认识术前口服碳水化合物对老年患者的安全性及可行性，将有助于降低老年患者术后谵妄的发生率，并且促进老年患者的早日康复。本文就术前口服碳水化合物对老年患者术后谵妄的影响做一综述。
Abstract: With the aging population, the number of elderly patients opting for surgical procedures is steadily increasing. However, due to physiological changes in the elderly, poor nutritional status before sur-gery, and prolonged preoperative fasting, the incidence of postoperative delirium in older patients is increased. Preoperative carbohydrate intake, as a contemporary element of the Enhanced Re-covery After Surgery (ERAS) paradigm, has become a clinical research focus for its role in prevent-ing postoperative delirium. Fully understanding the safety and feasibility of preoperative oral car-bohydrates in elderly patients could help reduce the incidence of postoperative delirium and pro-mote early recovery in this population. This article provides a comprehensive review of the impact of preoperative oral carbohydrate intake on postoperative delirium in elderly patients.
文章引用：马紫云, 蔡小丽. 术前口服碳水化合物对老年患者术后谵妄影响的研究进展[J]. 临床医学进展, 2024, 14(2): 4526-4532. https://doi.org/10.12677/ACM.2024.142628

参考文献

[1] Oh, E.S., Fong, T.G., Hshieh, T.T. and Inouye, S.K. (2017) Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA, 318, 1161-1174. [Google Scholar] [CrossRef] [PubMed]
[2] Evered, L., Silbert, B., Knopman, D.S., et al. (2018) Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Sur-gery-2018. Anesthesiology, 129, 872-879. [Google Scholar] [CrossRef] 
[3] Bai, J., Liang, Y., Zhang, P., et al. (2020) Association be-tween Postoperative Delirium and Mortality in Elderly Patients Undergoing Hip Fractures Surgery: A Meta-Analysis. Osteoporosis International, 31, 317-326. [Google Scholar] [CrossRef] [PubMed]
[4] Shi, Z., Mei, X.C., Li, C., et al. (2019) Postoperative Delirium Is Associated with Long-Term Decline in Activities of Daily Living. Anesthesiology, 131, 492-500. [Google Scholar] [CrossRef] 
[5] Namirembe, G.E., Baker, S., Albanese, M., et al. (2023) Association between Postoperative Delirium and Long-Term Subjective Cognitive Decline in Older Patients Undergoing Cardiac Surgery: A Secondary Analysis of the Minimizing Intensive Care Unit Neurological Dysfunction with Dexme-detomidine-Induced Sleep Trial. Journal of Cardiothoracic and Vascular Anesthesia, 37, 1700-1706. [Google Scholar] [CrossRef] [PubMed]
[6] Amer, M., Smith, M., Herbison, G., Plank, L. and McCall, J. (2017) Network Meta-Analysis of the Effect of Preoperative Carbohydrate Loading on Recovery after Elective Surgery. Journal of British Surgery, 104, 187-197. [Google Scholar] [CrossRef] [PubMed]
[7] Hirsch, K.R., Wolfe, R.R. and Ferrando, A.A. (2021) Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients, 13, Article No. 1675. [Google Scholar] [CrossRef] [PubMed]
[8] Brown, C.H. (2014) Delirium in the Cardiac Surgical ICU. Current Opinion in Anesthesiology, 27, 117-122. [Google Scholar] [CrossRef] 
[9] Bin Abd Razak, H.R. and Yung, W.Y. (2015) Postopera-tive Delirium in Patients Undergoing Total Joint Arthroplasty: A Systematic Review. The Journal of Arthroplasty, 30, 1414-1417. [Google Scholar] [CrossRef] [PubMed]
[10] Oldroyd, C., Scholz, A.F.M., Hinchliffe, R.J., et al. (2017) A Systematic Review and Meta-Analysis of Factors for Delirium in Vascular Surgical Patients. Journal of Vas-cular Surgery, 66, 1269-1279.e1269. [Google Scholar] [CrossRef] [PubMed]
[11] Crocker, E., Beggs, T., Hassan, A., et al. (2016) Long-Term Effects of Postoperative Delirium in Patients Undergoing Cardiac Operation: A Systematic Review. The Annals of Thoracic Surgery, 102, 1391-1399. [Google Scholar] [CrossRef] [PubMed]
[12] Scholz, A.F., Oldroyd, C., McCarthy, K., Quinn, T.J. and Hewitt, J. (2016) Systematic Review and Meta-Analysis of Risk Factors for Postoperative Delirium among Older Pa-tients Undergoing Gastrointestinal Surgery. British Journal of Surgery, 103, e21-28. [Google Scholar] [CrossRef] [PubMed]
[13] Aitken, S.J., Blyth, F.M. and Naganathan, V. (2017) Incidence, Prognostic Factors and Impact of Postoperative Delirium after Major Vascular Surgery: A Meta-Analysis and Systematic Review. Vascular Medicine, 22, 387-397. [Google Scholar] [CrossRef] 
[14] Kostas, T.R., Zimmerman, K.M. and Rudolph, J.L. (2013) Im-proving Delirium Care: Prevention, Monitoring, and Assessment. Neurohospitalist, 3, 194-202. [Google Scholar] [CrossRef] [PubMed]
[15] Swarbrick, C. and Partridge, J. (2022) Evidence-Based Strategies to Reduce the Incidence of Postoperative Delirium: A Narrative Review. Anaesthesia, 77, 92-101. [Google Scholar] [CrossRef] [PubMed]
[16] Pandharipande, P., Shintani, A., Peterson, J., et al. (2006) Lorazepam Is an Independent Risk Factor for Transitioning to Delirium in Intensive Care Unit Patients. Anesthesiology, 104, 21-26. [Google Scholar] [CrossRef] [PubMed]
[17] Lee, H.B., Mears, S.C., Rosenberg, P.B., et al. (2011) Predisposing Factors for Postoperative Delirium after Hip Fracture Repair in Individuals with and without Dementia. Journal of the American Geriatrics Society, 59, 2306-2313. [Google Scholar] [CrossRef] [PubMed]
[18] Nekrosius, D., Kaminskaite, M., Jokubka, R., et al. (2019) Association of COMT Val(158)Met Polymorphism with Delirium Risk and Outcomes after Traumatic Brain Injury. The Journal of Neuropsychiatry and Clinical Neurosciences, 31, 298-305. [Google Scholar] [CrossRef] [PubMed]
[19] 陈焕庆. 老年患者髋部骨折术后谵妄的危险因素研究[J]. 中国乡村医药, 2013(14): 11-12.
[20] Neerland, B.E., Hall, R.J., Seljeflot, I., et al. (2016) Associations between Delirium and Preoperative Cerebrospinal Fluid C-Reactive Protein, Interleukin-6, and Interleukin-6 Receptor in Individu-als with Acute Hip Fracture. Journal of the American Geriatrics Society, 64, 1456-1463. [Google Scholar] [CrossRef] [PubMed]
[21] Zhang, D.F., Su, X., Meng, Z.-T., et al. (2018) Preoperative Severe Hypo-albuminemia Is Associated with an Increased Risk of Postoperative Delirium in Elderly Patients: Results of a Secondary Analysis. Journal of Critical Care, 44, 45-50. [Google Scholar] [CrossRef] [PubMed]
[22] Velayati, A., Vahdat Shariatpanahi, M., Dehghan, S., Zayeri, F. and Vahdat Shariatpanahi, Z. (2020) Vitamin D and Postoperative Delirium after Coronary Artery Bypass Grafting: A Pro-spective Cohort Study. Journal of Cardiothoracic and Vascular Anesthesia, 34, 1774-1779. [Google Scholar] [CrossRef] [PubMed]
[23] Tautenhahn, H.M., Krautscheid, A., Schulte, K., Settmacher, U. and Zanow, J. (2020) Prerehabilitation in Frail Patients: Frailty as a Risk Factor. Chirurgie, 91, 103-108. [Google Scholar] [CrossRef] [PubMed]
[24] Kong, C., Zhang, Y.H., Wang, C.D., et al. (2022) Comprehen-sive Geriatric Assessment for Older Orthopedic Patients and Analysis of Risk Factors for Postoperative Complications. BMC Geriatrics, 22, Article No. 644. [Google Scholar] [CrossRef] [PubMed]
[25] Zhu, T., Yu, J., Ma, Y., et al. (2022) Effectiveness of Periopera-tive Comprehensive Evaluation of Hip Fracture in the Elderly. Computational Intelligence and Neuroscience, 2022, Arti-cle ID: 4124354. [Google Scholar] [CrossRef] [PubMed]
[26] (2017) Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology, 126, 376-393. [Google Scholar] [CrossRef] 
[27] Varadhan, K.K., Lobo, D.N. and Ljungqvist, O. (2010) En-hanced Recovery after Surgery: The Future of Improving Surgical Care. Critical Care Clinics, 26, 527-547. [Google Scholar] [CrossRef] [PubMed]
[28] Sánchez, C.A. and Papapietro, V.K. (2017) Perioperative Nutrition in ERAS Protocols. Revista Médica de Chile, 145, 1447-1453. [Google Scholar] [CrossRef] [PubMed]
[29] Heming, N., Moine, P., Coscas, R. and Annane, D. (2020) Perioperative Fluid Management for Major Elective Surgery. British Journal of Surgery, 107, e56-e62. [Google Scholar] [CrossRef] [PubMed]
[30] Berretta, P., De Angelis, V., Alfonsi, J., et al. (2022) Enhanced Recovery after Minimally Invasive Heart Valve Surgery: Early and Midterm Outcomes. International Journal of Cardiology, 370, 98-104. [Google Scholar] [CrossRef] [PubMed]
[31] Ackerman, R.S., Tufts, C.W., De Pinto, D.G., et al. (2020) How Sweet Is This? A Review and Evaluation of Preoperative Carbohydrate Loading in the Enhanced Recovery after Surgery Model. Nutrition in Clinical Practice, 35, 246-253. [Google Scholar] [CrossRef] [PubMed]
[32] Choi, Y.S., Cho, B.W., Kim, H.J., et al. (2022) Effect of Preoperative Oral Carbohydrates on Insulin Resistance in Older Adults Who Underwent Total Hip or Knee Arthroplasty: A Prospective Randomized Trial. Journal of the American Academy of Orthopaedic Surgeons, 30, 971-978. [Google Scholar] [CrossRef] 
[33] Garg, K.K., et al. (2023) Assessment of Gastric Residual Vol-ume with Ultrasound in Children at Fasting and after Oral Intake of Carbohydrate-Rich Fluid in the Preoperative Period. Journal of Indian Association of Pediatric Surgeons, 28, 227-232.
[34] Pogatschnik, C. and Steiger, E. (2015) Review of Preoperative Carbohydrate Loading. Nutrition in Clinical Practice, 30, 660-664. [Google Scholar] [CrossRef] [PubMed]
[35] Bilku, D., Dennison, A., Hall, T., Metcalfe, M. and Garcea, G. (2014) Role of Preoperative Carbohydrate Loading: A Systematic Review. The Annals of the Royal College of Surgeons of England, 96, 15-22. [Google Scholar] [CrossRef] 
[36] Smith, M.D., McCall, J., Plank, L., et al. (2014) Pre-operative Carbohydrate Treatment for Enhancing Recovery after Elective Surgery. Cochrane Database of Systematic Re-views, No. 8, CD009161. [Google Scholar] [CrossRef] 
[37] Talutis, S.D., Lee, S.Y., Cheng, D., et al. (2020) The Im-pact of Preoperative Carbohydrate Loading on Patients with Type II Diabetes in an Enhanced Recovery after Surgery Protocol. The American Journal of Surgery, 220, 999-1003. [Google Scholar] [CrossRef] [PubMed]
[38] Asakura, A., Mihara, T. and Goto, T. (2015) The Effect of Preoperative Oral Carbohydrate or Oral Rehydration Solution on Postoperative Quality of Recovery: A Randomized, Controlled Clinical Trial. PLOS ONE, 10, e0133309. [Google Scholar] [CrossRef] [PubMed]
[39] Awad, S., Varadhan, K.K., Ljungqvist, O. and Lobo, D.N. (2013) A Meta-Analysis of Randomised Controlled Trials on Preoperative Oral Carbohydrate Treatment in Elective Sur-gery. Clinical Nutrition, 32, 34-44. [Google Scholar] [CrossRef] [PubMed]
[40] Kuiper, M., Gillingham, M., Martin, J., Gardner, D. and Van Cal-car, S. (2023) The Effect of Preoperative Carbohydrate Intake on Length of Stay and Postoperative Recovery Following Laparoscopic Living Donor Nephrectomy. Journal of Renal Nutrition, 33, 405-411. [Google Scholar] [CrossRef] [PubMed]
[41] Cheng, P.L., Loh, E.W., Chen, J.T. and Tam, K.W. (2021) Effects of Preoperative Oral Carbohydrate on Postoperative Discomfort in Patients Undergoing Elective Surgery: A Meta-Analysis of Randomized Controlled Trials. Langenbeck’s Archives of Surgery, 406, 993-1005. [Google Scholar] [CrossRef] [PubMed]
[42] Ljungqvist, O., Francis, N.K. and Urman, R.D. (2020) Enhanced Recovery after Surgery: A Complete Guide to Optimizing Outcomes. Springer, Berlin. [Google Scholar] [CrossRef] 
[43] Rizvanović, N., et al. (2023) Effects of Preoperative Oral Carbo-hydrate Loading on Neutrophil/Lymphocyte Ratio and Postoperative Complications following Colorectal Cancer Surgery: A Randomized Controlled Study. European Surgical Research, 64, 278-285. [Google Scholar] [CrossRef] [PubMed]
[44] Ackerman, R.S., et al. (2020) How Sweet Is This? A Review and Evalua-tion of Preoperative Carbohydrate Loading in the Enhanced Recovery after Surgery Model. Nutrition in Clinical Practice, 35, 246-253. [Google Scholar] [CrossRef] [PubMed]
[45] Xu, Q.Q., Zhu, W.X., Xiong, H.L., Zeng, F.L. and Du, Y. (2023) Safety and Effectiveness for Oral Intake of Carbohydrate-Rich Drink at Preoperative 2 Hours before Painless Colonoscopy. Medicine (Baltimore), 102, e33899. [Google Scholar] [CrossRef] 
[46] Atkins, K.J., Scott, D.A., Silbert, B., Pike, K.E. and Evered, L. (2021) Preventing Delirium and Promoting Long-Term Brain Health: A Clinical Trial Design for the Perioperative Cognitive Enhancement (PROTECT) Trial. Journal of Alzheimer’s Disease, 83, 1637-1649. [Google Scholar] [CrossRef] 
[47] Liu, H., Dai, M., Guan, H., et al. (2021) Preoperative Prognostic Nutri-tional Index Value Is Related to Postoperative Delirium in Elderly Patients after Noncardiac Surgery: A Retrospective Cohort Study. Risk Management and Healthcare Policy, 14, 1-8. [Google Scholar] [CrossRef] 
[48] Olotu, C., Weimann, A., Bahrs, C., et al. (2019) The Perioperative Care of Older Patients: Time for a New, Interdisciplinary Approach. Deutsches Ärzteblatt International, 116, 63-69. [Google Scholar] [CrossRef] [PubMed]
[49] Lester, P.E., Ripley, D., Grandelli, R., et al. (2022) Interdisciplinary Protocol for Surgery in Older Persons: Development and Implementation. Journal of the American Medical Directors Association, 23, 555-562. [Google Scholar] [CrossRef] [PubMed]
[50] Mörgeli, R., et al. (2017) Wie können postoperative Komplika-tionen bei Patienten mit Frailty vermieden werden? AINS-Anästhesiologie• Intensivmedizin• Notfallmedizin• Schmerz-therapie, 52, 785-797. [Google Scholar] [CrossRef] [PubMed]
[51] Ambulkar, R., Manampadi, U., Bhosale, S., et al. (2021) Pre-Induction Ultrasonographic Evaluation of Gastric Residual Volume in Elective Gastrointestinal Cancer Surgeries. Indian Journal of Surgical Oncology, 12, 841-846. [Google Scholar] [CrossRef] [PubMed]

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