不同剂量胰岛素滴鼻对老年食管癌根治术患者术后谵妄的影响  

Effects of different doses of insulin nasal drops on postoperative delirium in elderly patients undergoing radical esophageal cancer surgery

作　　者：施琴 黄青青 林露 刘敏 曾镜铮 巩固 SHI Qin;HUANG Qingqing;LIN Lu;LIU Min;ZENG Jingzheng;GONG Gu(Department of Anesthesiology,North Sichuan Medical College,Nanchong,Sichuan 637000,China;Department of Anesthesiology,General Hospital of Chinese People’s Liberation Army Western Theater,Chengdu,Sichuan 610083,China)

机构地区：[1]川北医学院麻醉学系,四川南充637000 [2]中国人民解放军西部战区总医院麻醉科,成都610083

出　　处：《重庆医学》2023年第19期2930-2934,2939,共6页Chongqing medicine

基　　金：2019军委后勤面上项目(CLB19J051);中国人民解放军西部战区总医院青年孵化项目(2021-XZYG-C25)。

摘　　要：目的观察不同剂量胰岛素滴鼻对老年食管癌根治术患者术后谵妄(POD)的影响及副作用。方法选择西部战区总医院2021年11月至2022年6月拟行食管癌根治术的老年患者100例,按照随机数字表法分成4组,每组25例。对照组(C组):生理盐水滴鼻;胰岛素组1(I1组):20 U(0.5 mL)胰岛素滴鼻;胰岛素组2(I2组):30 U(0.75 mL)胰岛素滴鼻;胰岛素组3(I3组):40 U(1 mL)胰岛素滴鼻。4组患者均给予相应溶液滴鼻,每天2次,术前2 d开始使用,直至手术当天麻醉前10 min,共滴鼻5次。记录4组患者术后3 d内POD总发生率,使用实时持续葡萄糖监测系统监测受试者在试验过程中的血糖变异相关指标,以及给药后鼻腔刺激性症状发生率。结果与C组相比,I1组、I2组与I3组术后3 d内POD总发生率明显降低(P<0.05);与I1组相比,I2组、I3组术后3 d内POD总发生率明显降低(P<0.05);I3组术后3 d内POD总发生率与I2组比较,差异无统计学意义(P>0.05)。与C组相比,I1组、I2组给药后低血糖发生总次数、血糖变异系数和鼻腔刺激性症状发生率均差异无统计学意义;与C组、I1组、I2组相比,I3组给药后低血糖发生总次数、血糖变异系数和鼻腔刺激性发生率均明显增加(P<0.05)。结论术前胰岛素(30 U/次)重复滴鼻可降低老年食管癌根治术患者POD发生率,同时不增加胰岛素不良反应。Objective To observe the effect and side effects of different doses of insulin nasal drops on postoperative delirium(POD)on postoperative delirium in elderly patients undergoing radical esophageal cancer surgery.Methods A total of 100 elderly patients undergoing radical resection of esophageal cancer from November 2021 to June 2022 were selected and divided into four groups,with 25 cases in each group according to the random number table method.The control group(group C):normal saline nasal drip;The insulin group 1(group I1):20 U(0.5 mL)insulin nasal drip;The insulin group 2(group I2):30 U(0.75 mL)insulin nasal drip;The insulin group 3(group I3):40 U(1 mL)insulin nasal drops.All patients in the four groups were given the corresponding nasal drops twice a day,starting from two days before the operation until ten minutes before anesthesia on the day of the operation.The total incidence of POD within three days after the operation of the four groups was recorded.The related indexes of blood glucose variation and the incidence of nasal irritation after administration were monitored by real-time continuous glucose monitoring system.Results Compared with the group C,the total incidence of POD in the group I1,I2,and I3 within three days after surgery was significantly lower(P<0.05).Compared with the group I2,there was no significant difference in the total incidence of POD in the group I3 within three days after the operation(P>0.05).Compared with the group C,there was no significant difference in the total number of hypoglycemia,blood glucose variation coefficient(CV)and incidence of nasal irritation in the group I1 and the group I2 after administration;compared with the group C,the group I1 and the group I2,the total number of hypoglycemia,blood glucose variation coefficient(CV)and incidence of nasal irritation in the group I3 were significantly increased after administration(P<0.05).Conclusion Repeated nasal drops of insulin 30 U/time can reduce the incidence of POD in elderly patients undergoing radical of esophagea

关 键 词：术后谵妄 胰岛素 经鼻给药 持续葡萄糖监测系统 不良反应 

分 类 号：R614[医药卫生—麻醉学]