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已发表论文
麻黄碱与伪麻黄碱对老年患者全髋关节或全膝关节置换术后谵妄的影响：一项随机对照试验
Authors Song JL , Zhang JT, Wang XJ, Yu X, Li Q, Lu B, Chen GY
Received 14 July 2025
Accepted for publication 27 November 2025
Published 12 December 2025 Volume 2025:19 Pages 10991—11005
DOI https://doi.org/10.2147/DDDT.S553478
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Anastasios Lymperopoulos
Jian-Li Song,* Jun-Tao Zhang,* Xu-Jiao Wang, Xuan Yu, Qiang Li, Bin Lu, Guan-Yu Chen
Department of Anesthesiology, Zigong Fourth People’s Hospital, Zigong City, Sichuan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Bin Lu; Guan-Yu Chen, Zigong Fourth People’s Hospital, No. 19, Tanmulin Street, Ziliujing District, Zigong City, Sichuan, People’s Republic of China, Email adg123456@vip.qq.com; 741755319@qq.com
Background: Postoperative delirium (POD) is a common complication in elderly patients. Since ephedrine and phenylephrine have different effects on cerebral perfusion and oxygenation, this randomized controlled trial aimed to compare the impact of these two drugs on the incidence of POD in elderly patients undergoing total hip or knee arthroplasty under general anesthesia.
Patients and Methods: A total of 142 elderly patients, aged 65 to 80 years, who underwent elective surgery for total hip or knee arthroplasty were randomly assigned to either the ephedrine group (Group E) or the phenylephrine group (Group P). POD was evaluated using the 3-minute Diagnostic Confusion Assessment Method (3D-CAM). The primary outcome was the incidence of POD within three days after surgery, while secondary outcomes included the subtypes of delirium, intraoperative hemodynamic changes, intraoperative analgesic consumption, and the occurrence of intraoperative and postoperative adverse events.
Results: Delirium occurred in 5 out of 65 cases (7.7%) in Group E and in 15 out of 67 cases (22.4%) in Group P (relative risk [RR], 0.344; 95% confidence interval [CI], 0.132 to 0.891; p = 0.019). Compared to Group P, Group E exhibited a significantly lower incidence of intraoperative bradycardia (RR, 0.241; 95% CI, 0.114 to 0.508; p < 0.001). However, Group E also demonstrated a significantly higher consumption of intraoperative opioids (median difference [MD], 23.0; 95% CI, 2.0 to 25.0 mg; p = 0.020). Notably, despite the higher intraoperative opioid consumption in Group E, there was no statistically significant difference in postoperative pain scores between the two groups (p > 0.05). Additionally, there were no statistically significant differences between the two groups in other indicators, including intraoperative hemodynamic changes and the incidence of postoperative nausea and vomiting (p > 0.05).
Conclusion: In conclusion, among elderly patients undergoing hip or knee arthroplasty, the use of ephedrine to correct intraoperative hypotension was associated with a reduced incidence of POD within three days compared to phenylephrine. However, the absence of cerebral oxygen saturation monitoring and the limited follow-up period of only three days for POD assessment represent significant limitations. These factors should be carefully considered when interpreting our results.
Keywords: ephedrine, phenylephrine, delirium, elderly patients, orthopedic surgery
Department of Anesthesiology, Zigong Fourth People’s Hospital, Zigong City, Sichuan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Bin Lu; Guan-Yu Chen, Zigong Fourth People’s Hospital, No. 19, Tanmulin Street, Ziliujing District, Zigong City, Sichuan, People’s Republic of China, Email adg123456@vip.qq.com; 741755319@qq.com
Background: Postoperative delirium (POD) is a common complication in elderly patients. Since ephedrine and phenylephrine have different effects on cerebral perfusion and oxygenation, this randomized controlled trial aimed to compare the impact of these two drugs on the incidence of POD in elderly patients undergoing total hip or knee arthroplasty under general anesthesia.
Patients and Methods: A total of 142 elderly patients, aged 65 to 80 years, who underwent elective surgery for total hip or knee arthroplasty were randomly assigned to either the ephedrine group (Group E) or the phenylephrine group (Group P). POD was evaluated using the 3-minute Diagnostic Confusion Assessment Method (3D-CAM). The primary outcome was the incidence of POD within three days after surgery, while secondary outcomes included the subtypes of delirium, intraoperative hemodynamic changes, intraoperative analgesic consumption, and the occurrence of intraoperative and postoperative adverse events.
Results: Delirium occurred in 5 out of 65 cases (7.7%) in Group E and in 15 out of 67 cases (22.4%) in Group P (relative risk [RR], 0.344; 95% confidence interval [CI], 0.132 to 0.891; p = 0.019). Compared to Group P, Group E exhibited a significantly lower incidence of intraoperative bradycardia (RR, 0.241; 95% CI, 0.114 to 0.508; p < 0.001). However, Group E also demonstrated a significantly higher consumption of intraoperative opioids (median difference [MD], 23.0; 95% CI, 2.0 to 25.0 mg; p = 0.020). Notably, despite the higher intraoperative opioid consumption in Group E, there was no statistically significant difference in postoperative pain scores between the two groups (p > 0.05). Additionally, there were no statistically significant differences between the two groups in other indicators, including intraoperative hemodynamic changes and the incidence of postoperative nausea and vomiting (p > 0.05).
Conclusion: In conclusion, among elderly patients undergoing hip or knee arthroplasty, the use of ephedrine to correct intraoperative hypotension was associated with a reduced incidence of POD within three days compared to phenylephrine. However, the absence of cerebral oxygen saturation monitoring and the limited follow-up period of only three days for POD assessment represent significant limitations. These factors should be carefully considered when interpreting our results.
Keywords: ephedrine, phenylephrine, delirium, elderly patients, orthopedic surgery