来源：小麻哥的日常

摘要译文（供参考）

卡巴拉汀对术后谵妄和认知障碍的影响：

一项随机临床试验

背景：

谵妄（Delirium）是一种急性和短暂的脑功能障碍，经常发生在手术后患者中。卡巴拉汀（Rivastigmine）是一种胆碱酯酶抑制剂药物，近年来已被提议作为辅助药物，尽管有重要的理论证据，但很少有关于其对谵妄影响的临床研究。

目的：

由于胆碱酯酶抑制剂在儿科和成人手术中的广泛使用，本研究旨在研究卡巴拉汀作为胆碱酯酶抑制剂对根治术后谵妄的影响。

方法：

在这项随机双盲临床试验中，一百名招募的患者被随机分配到卡巴拉汀（n = 50）或安慰剂（n = 50）组，我们通过谵妄评估量表（Confusion Assessment Method，CAM）测量对术后谵妄的影响，并通过简易精神状态检查量表（Mini-Mental State Examination，MMSE）测量认知障碍。我们使用单变量和多变量逻辑回归模型评估了这种假设的影响。

结果：

通过 CAM 评分发现卡术后第一天谵妄减少显著相关（比值比 （OR） = 0.35，95%置信区间 （CI） 0.11 至 0.97，p = 0.05），MMSE测量发现巴拉汀治疗与术后认知障碍减轻显著相关（OR = 0.25，95% CI 0.1 至 0.59，p = 0.0022）。

在控制年龄、失血量和术后血钠水平后，这些关联变得更强：谵妄（OR = 0.23，95% CI 0.05 至 0.92，p = 0.05）、认知障碍（OR = 0.12，95% CI 0.03 至 0.42，p = 0.000178）。

结论：

我们的随机临床试验的重要结果是，术前卡巴拉汀治疗可能与术后谵妄和术后认知障碍患者的大幅下降有关。

关键词：

麻醉;胆碱酯酶抑制剂;认知功能障碍;谵妄;术后期;卡巴拉汀。

原文摘要

The impact of rivastigmine on post-surgical delirium and cognitive impairment; a randomized clinical trial

Background:Delirium is an acute and transient disorder of brain function that often occurs in post-surgical patients. Rivastigmine is a cholinesterase inhibitor drug that has been proposed as an adjuvant drug in recent years, still, despite significant theoretical evidence, few clinical studies have been performed on its impact on delirium.

Aim:Due to the widespread use of cholinesterase inhibitors in pediatric and adult surgery, the present study aims to investigate the impact of Rivastigmine as a cholinesterase inhibitor on delirium after radical surgery.

Methods:In this randomized double-blind clinical trial, a hundred recruited patients were randomly assigned to either Rivastigmine (n = 50) or placebo (n = 50) groups, and we measured post-operative impact on delirium, by Confusion Assessment Method (CAM) score, and cognitive impairment, by the Mini-Mental State Examination (MMSE). Our univariate and multivariate logistical regression models assessed this hypothesized impact.

Results:Treatment with Rivastigmine was significantly associated with reduced day one post-op delirium, as measured by CAM score (Odds Ratio (OR) = 0.35, 95% Confidence Interval (CI) 0.11 to 0.97, p = 0.05), and cognitive impairment, as measured by MMSE (OR = 0.25, 95% CI 0.1 to 0.59, p = 0.0022). These associations became stronger after controlling for age, blood loss, and post-op blood sodium levels: Delirium (OR = 0.23, 95% CI 0.05 to 0.92, p = 0.05), cognitive impairment (OR = 0.12, 95% CI 0.03 to 0.42, p = 0.000178).

Conclusion:The significant result of our randomized clinical trial is that pre-op Rivastigmine treatment may be associated with a substantial drop in patients experiencing post-op delirium and post-op cognitive impairment.

Keywords:anesthesia; cholinesterase inhibitor; cognitive dysfunction; delirium; postoperative period; rivastigmine.