围术期外源性褪黑素干预对老年患者术后谵妄和血清S100β的影响  

Influence of perioperative exogenous melatonin on postoperative delirium and serum S100β level in elderly patients

作　　者：王奕皓[1] 荆艳[1] 李岩[2] 张楠楠[3] 刘显珍[1] 杨洪光[1] 艾登斌[1] WANG Yihao;JING Yan;LI Yan;ZHANG Nannan;LIU Xianzhen;YANG Hongguang;AI Dengbin(Department of Anesthetic Surgery, Qingdao Municipal Hospital, Qingdao Municipal Clinical Research Center of Anesthesiology, Qingdao 266011, China;Department of Obstetrics,the Affiliated Hospital of Qingdao University, Qingdao 266000, China;Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao 266000,China)

机构地区：[1]青岛市市立医院本部麻醉手术科,青岛市临床麻醉研究中心,山东青岛266011 [2]青岛大学附属医院产科,山东青岛266000 [3]青岛大学附属医院麻醉科,山东青岛266000

出　　处：《大连医科大学学报》2018年第6期533-536,共4页Journal of Dalian Medical University

摘　　要：目的探讨围术期外源性褪黑素干预对老年患者术后谵妄和血清S100β的影响。方法择期全麻下行全髋置换术患者60例,年龄65～75岁,体重50～80 kg,ASA分级Ⅰ～Ⅱ级。采用随机数字表法,将其分为两组:对照组(C组,n=30)和褪黑素组(M组,n=30)。M组于麻醉前3天晚,术前90 min及术后1天晚分别服用褪黑素6mg; C组给予服用安慰剂。分别于麻醉前(T0)、手术结束6小时(T1)、术后24小时(T2)、术后48小时(T3)、术后72小时(T4)采集右颈内静脉血监测S100β。采用意识错乱评估方法(CAM)记录T0、T2、T3、及T4时点术后谵妄发生情况。结果与T0比较,C组T1-2时点S100β明显升高(P <0. 05)。与T0比较,M组T1-4时点S100β差异无统计学意义(P> 0. 05)。与C组比较,M组T1-2时点S100β明显降低(P <0. 05)。术后72小时内M组谵妄的发生率与C组比较明显降低,差异具有统计学意义(P <0. 05)。结论围术期口服褪黑素能够减少老年患者术后谵妄的发生,降低术后血清S100β的表达水平。Objective To evaluate the influence of perioperative exogenous melatonin on postoperative delirium and serum S100βlevel in elderly patients.Methods Sixty patients,who were scheduled for total hip arthroplasty under general anesthesia(aged 65 to 75 years old,weighted 50-80 kg,ASAⅠorⅡ),were randomized into two groups(n=30 each):control group(group C)and melatonin group(group M).The patients in group M were given melatonin 6 mg orally at the night 3 days before anesthesia,90 min before surgery and 1 day after surgery,respectively;while the patients in group C received placebo.Blood were taken from right internal jugular vein before anesthesia(T0),at 6 h(T1),24 h(T2),48 h(T3),and 72 h(T4)after surgery.Serum level of S100βwas measured.Confused Assessment Method(CAM)was used to evaluate for postoperative delirium rating scale before anesthesia(T0),at 24 h(T2),48h(T3)and 72 h(T4)after surgery.Results Compared with T0,serum S100βlevels were elevated at T1-2(P<0.05)in group C.The difference of serum S100βlevels was not statistically significant at T1-2(P>0.05)in group M.Compared with group C,serum S100βlevels were declined significantly at T1-2(P<0.05)in group M.Compared with group C,the postoperative delirium rating scale was lower in group M within 72 h after surgery(P<0.05).Conclusion Perioperative exogenous melatonin can prevent postoperative delirium and decrease serum S100βlevel in elderly patients after surgery.

关 键 词：褪黑素 老年患者 术后谵妄 

分 类 号：R614.2[医药卫生—麻醉学]