胰岛素鼻内给药与术后谵妄的进展  

Progress of intranasal insulin administration and postoperative delirium

作　　者：黄青青 雷妮 李胜男 魏瑶 袁利邦 巩固 HUANG Qingqing;LEI Ni;LI Shengnan;WEI Yao;YUAN Libang;GONG Gu(Department of Anesthesiology,the General Hospital of Western Theater Command,Chengdu 610083,China)

机构地区：[1]西部战区总医院麻醉科,成都市610083

出　　处：《临床麻醉学杂志》2022年第1期101-104,共4页Journal of Clinical Anesthesiology

基　　金：2019军队后勤科研项目(CLB19J051)。

摘　　要：术后谵妄(POD)是常见的术后并发症,主要表现为思维紊乱、定向力障碍、注意力不集中、昼夜颠倒、意识改变等症状,可导致术后并发症增多,围术期死亡率增高。目前,POD的发病原因尚未明确,也无安全有效的防治方法。胰岛素鼻内给药是与脑能量代谢异常相关的认知障碍的重要治疗方法,近年来得到广泛关注。脑中胰岛素浓度增高可改善学习记忆功能,特别是海马依赖性(陈述性)记忆,鼻内给药是增加脑中胰岛素的主要方式。基于POD现有的病理生理机制,鼻内给予胰岛素可能通过增加脑部血流量、减轻炎症反应、改善睡眠-觉醒周期的紊乱、降低τ蛋白过度磷酸化、减少Aβ的沉积等途径预防和减少POD的发生。Postoperative delirium(POD)is one of the common postoperative complications,mainly manifested by thinking disorders,disorientation,inattention,nyctohemeral rhythm inversion,consciousness changes and other symptoms,which can lead to increased postoperative complications and perioperative mortality.At present,the specific cause of POD is not clear,and there is no safe and effective prevention and treatment method.Intranasal insulin administration is an important treatment for cognitive disorders associated with abnormal brain energy metabolism,which has attracted widespread attention in recent years.It has shown that enhancing the action of insulin in the brain improves learning and memory,especially hippocampal(declarative)memory.Intranasal administration is the main way to increase insulin in the brain.Based on the existing pathophysiological mechanism of POD,intranasal insulin may prevent and reduce POD by increasing brain blood flow,reducing inflammatory response,improving sleep-wake cycle disorder,reducingτprotein hyperphosphorylation,and reducing Aβdeposition.

关 键 词：胰岛素 鼻内给药 老年 全身麻醉 术后谵妄 

分 类 号：R614[医药卫生—麻醉学]