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

关键词:  褪黑素  老年患者  术后谵妄

Key words:  melatonin  elderly patients  postoprative delirium

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6 mg；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。

Abstract:

Objective　To evaluate the influence of perioperative exogenous melatonin on postoperative delirium and serum S100β level 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 S100β was 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 S100β levels were elevated at T1-2 (P<0.05) in group C. The difference of serum S100β levels was not statistically significant at T1-2(P>0.05) in group M. Compared with group C，serum S100β levels 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 S100β level in elderly patients after surgery.