褪黑素预防老年腹部大手术患者术后谵妄的效果观察  

Effect of melatonin in the prevention of postoperative delirium among the elderly patients undergoing major abdominal surgeries

作　　者：陈梅 梁燕霞[2] CHEN Mei;LIANG Yan-xia(Department of Surgery,Wuchuan People's Hospital,Wuchuan 524500,China;Intensive Care Unit,Wuchuan People's Hospital,Wuchuan 524500,China)

机构地区：[1]广东省吴川市人民医院外科,广东湛江524500 [2]广东省吴川市人民医院重症科,广东湛江524500

出　　处：《广东医科大学学报》2020年第2期230-233,共4页Journal of Guangdong Medical University

摘　　要：目的观察口服褪黑素预防老年腹部大手术患者术后谵妄的临床效果及安全性。方法选择90例接受全麻气管插管腹部切开大手术的老年患者,随机分为观察组和对照组,每组45例。观察组给予褪黑素治疗,对照组不给予褪黑素治疗。用意识混乱评估法观察术后7 d内的谵妄发生情况及记忆谵妄评定量表(MDAS)评估谵妄的严重程度。采血检测并比较两组患者的血清S100B蛋白及神经元特异性烯醇化酶(NSE)水平。记录并比较两组睡眠-觉醒周期紊乱、延迟拔除气管插管、转入ICU、二次手术、死亡等并发症的发生情况。结果观察组术后谵妄16例(35.6%),少于对照组的27例(60.0%),P<0.05。观察组谵妄病例的MDAS评分低于对照组(P<0.05)。在术后第3、5、7天,观察组患者血清S100B水平均低于同期的对照组(P<0.05或0.01);第3天血清NSE水平也低于同期对照组(P<0.01)。观察组的S100B和NSE水平比对照组下降更快。两组的睡眠-觉醒周期紊乱、延迟拔除气管插管、转入ICU、二次手术、死亡等方面的并发症发生情况差异无统计学意义(P>0.05)。结论口服褪黑素可预防老年人腹部大手术后谵妄的发生,能促进血脑屏障功能恢复。Objective To observe the effect and safety of melatonin in the prevention of postoperative delirium among the elderly patients undergoing major abdominal surgeries.Methods A total of 90 patients undergoing major abdominal surgeries under general anaesthesia were recruited and randomized into the Observation Group(OG,45 patients)and the Control Group(CG,45 patients).The OG received treatment with melatonin while the CG did not.The Confusion Assessment Method(CAM)was used to assess the incidence of delirium within 7 d after the operation and the Memorial Delirium Assessment Scale(MDAS)were used to evaluate the severity of delirium.The blood of the two groups was sampled,and the serum S100 B protein and neuron-specific enolase(NSE)levels were measured and compared between the two groups.The sleep-wake cycle disturbance,delayed extubation,ICU admission,a second operation,impatient death and other complications of the two groups were recorded and compared.Results There were 16 patients(35.6%)with postoperative delirium in the OG while 27 patients(60.0%)with postoperative delirium in the CG,and the difference was statistically significant(P<0.05).The serum S100 B level in the OG at Day 3,5 and 7 after the operation was significantly lower than that in the CG(P<0.05 or 0.01).The serum NSE level in the OG at Day 3 after the operation was lower than that in the OG(P<0.01).The serum levels of S100 B and NSE of the OG decreased faster compared with the OG.There was no statistical difference in the incidence of sleep-wake cycle disturbance,delayed extubation,ICU admission,a second operation and impatient death between the two groups(P>0.05).Conclusion Oral administration of melatonin is an effective and safe solution to prevent postoperative delirium in the elderly patients undergoing major abdominal surgeries.Melatonin may help to restore the blood brain-barrier function and improve the sleep-wake cycle disturbance.

关 键 词：术后谵妄 褪黑素 睡眠-觉醒周期紊乱 血脑屏障功能 

分 类 号：R619[医药卫生—外科学]