Hongrui Zhu, Zaibao Wang, Sheng Ding, Chunliu Li, Li Xie, Yan Meng, Jiawei Xiao, Wuyang Zhang, Min Xu, Chen Gao, Keqiang He, Sheng Wang
{"title":"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。","authors":"Hongrui Zhu, Zaibao Wang, Sheng Ding, Chunliu Li, Li Xie, Yan Meng, Jiawei Xiao, Wuyang Zhang, Min Xu, Chen Gao, Keqiang He, Sheng Wang","doi":"10.2147/DDDT.S548597","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>No significant differences were observed between the two groups in the incidence of POCD (<i>p</i>>0.05) or POD (<i>p</i>>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 (<i>p</i> < 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 (<i>p</i> = 0.037). Group F exhibited higher mean arterial pressure (MAP) at the beginning of the operation (<i>p</i>=0.022) and a longer extubation time and waking time (<i>p</i> < 0.001) but had significantly lower incidences of injection pain (<i>p</i>=0.018) and postoperative nausea and vomiting (<i>p</i>=0.037). Binary logistic regression identified age as an independent risk factor for PND [OR=1.149, <i>p</i>=0.006], while preoperative MMSE score was a protective factor [OR=0.693, <i>p</i> = 0.002].</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11290,"journal":{"name":"Drug Design, Development and Therapy","volume":"19 ","pages":"8195-8209"},"PeriodicalIF":5.1000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439819/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of Fospropofol Disodium on Perioperative Neurocognitive Function in Elderly Patients Undergoing Total Hip Arthroplasty.\",\"authors\":\"Hongrui Zhu, Zaibao Wang, Sheng Ding, Chunliu Li, Li Xie, Yan Meng, Jiawei Xiao, Wuyang Zhang, Min Xu, Chen Gao, Keqiang He, Sheng Wang\",\"doi\":\"10.2147/DDDT.S548597\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>No significant differences were observed between the two groups in the incidence of POCD (<i>p</i>>0.05) or POD (<i>p</i>>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 (<i>p</i> < 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 (<i>p</i> = 0.037). Group F exhibited higher mean arterial pressure (MAP) at the beginning of the operation (<i>p</i>=0.022) and a longer extubation time and waking time (<i>p</i> < 0.001) but had significantly lower incidences of injection pain (<i>p</i>=0.018) and postoperative nausea and vomiting (<i>p</i>=0.037). Binary logistic regression identified age as an independent risk factor for PND [OR=1.149, <i>p</i>=0.006], while preoperative MMSE score was a protective factor [OR=0.693, <i>p</i> = 0.002].</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":11290,\"journal\":{\"name\":\"Drug Design, Development and Therapy\",\"volume\":\"19 \",\"pages\":\"8195-8209\"},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2025-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439819/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Drug Design, Development and Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/DDDT.S548597\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MEDICINAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Drug Design, Development and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/DDDT.S548597","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CHEMISTRY, MEDICINAL","Score":null,"Total":0}
Effect of Fospropofol Disodium on Perioperative Neurocognitive Function in Elderly Patients Undergoing Total Hip Arthroplasty.
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.
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
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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.
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