Effect of Fospropofol Disodium on Perioperative Neurocognitive Function in Elderly Patients Undergoing Total Hip Arthroplasty.

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-09-12 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S548597

Hongrui Zhu, Zaibao Wang, Sheng Ding, Chunliu Li, Li Xie, Yan Meng, Jiawei Xiao, Wuyang Zhang, Min Xu, Chen Gao, Keqiang He, Sheng Wang

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引用次数: 0

Abstract

Objective: This study aimed to compare the effects of fospropofol disodium and propofol on perioperative neurocognitive function in elderly patients undergoing total hip arthroplasty (THA), evaluating the non-inferiority of fospropofol disodium in preventing or reducing perioperative neurocognitive disorders (PND) and exploring optimal clinical anesthesia strategies.

Methods: A total of 180 elderly patients (aged 65~80 years) scheduled for THA between November 2022 and November 2024 were randomly assigned to the fospropofol disodium group (Group F, n=90) or the propofol group (Group P, n=90). Cognitive function was assessed preoperatively (1 day before surgery) and postoperatively (1, 3, 7 days, and 1 month) using the Modified Mini-Mental State Examination (MMSE), 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM), Digit Span Test (DST), Verbal Fluency Test (VFT), and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). The incidence of postoperative cognitive dysfunction (POCD) and delirium (POD), hemodynamic parameters, and adverse events were compared between the two groups.

Results: No significant differences were observed between the two groups in the incidence of POCD (p>0.05) or POD (p>0.05) at any postoperative time point. At the time point of 10 minutes after bone cement implantation (T4), the heart rate of patients in the Group F was higher than that of Group P (p < 0.0001). At the time of discharge from the PACU, the heart rate of patients in the Group F was lower than that of the Group P (p = 0.037). Group F exhibited higher mean arterial pressure (MAP) at the beginning of the operation (p=0.022) and a longer extubation time and waking time (p < 0.001) but had significantly lower incidences of injection pain (p=0.018) and postoperative nausea and vomiting (p=0.037). Binary logistic regression identified age as an independent risk factor for PND [OR=1.149, p=0.006], while preoperative MMSE score was a protective factor [OR=0.693, p = 0.002].

Conclusion: Fospropofol disodium may be a viable alternative in settings where injection pain and PONV are primary concerns, provided that hemodynamic stability is actively managed in elderly THA patients, with non-inferior efficacy in preventing PND compared to propofol and fewer adverse effects. Age and preoperative cognitive function are critical predictors of PND, warranting careful consideration in perioperative management.

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磷丙酚二钠对老年全髋关节置换术患者围手术期神经认知功能的影响。

目的：本研究旨在比较磷丙酚二钠与丙泊酚对老年全髋关节置换术患者围手术期神经认知功能的影响，评价磷丙酚二钠在预防或减少围手术期神经认知障碍（PND）方面的非劣效性，探讨临床最佳麻醉策略。方法：将于2022年11月~ 2024年11月行全髋关节置换术的老年患者180例（65~80岁）随机分为丙泊酚二钠组（F组，n=90）和丙泊酚组（P组，n=90）。术前（术前1天）和术后（术后1、3、7天和1个月）分别采用改进的简易精神状态检查（MMSE）、3分钟诊断性混乱评估法（3D-CAM）、数字广度测试（DST）、语言流畅性测试（VFT）和老年人认知能力下降信息问卷（IQCODE）评估认知功能。比较两组患者术后认知功能障碍（POCD）、谵妄（POD）发生率、血流动力学参数及不良事件。结果：两组术后各时间点POCD发生率（p>0.05）或POD发生率（p>0.05）均无显著差异。骨水泥植入后10分钟（T4）时，F组患者心率高于P组（P < 0.0001）。在PACU出院时，F组患者心率低于P组（P = 0.037）。F组患者术初平均动脉压（MAP）较高（p=0.022），拔管时间和清醒时间较长（p < 0.001），但注射疼痛发生率（p=0.018）和术后恶心呕吐发生率（p=0.037）明显降低。二元logistic回归发现年龄是PND的独立危险因素[OR=1.149, p=0.006]，而术前MMSE评分是PND的保护因素[OR=0.693, p= 0.002]。结论：在主要关注注射疼痛和PONV的情况下，如果在老年THA患者中积极管理血流动力学稳定性，磷丙酚二钠可能是一种可行的替代方案，与异丙酚相比，它在预防PND方面的效果不逊色，而且不良反应更少。年龄和术前认知功能是PND的重要预测因素，需要在围手术期管理中仔细考虑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.