依达拉奉对老年患者髋关节置换术术后谵妄的影响

The effects of edaravone on postoperative delirium in aged patients following total hip-replacement surgery region

目的术后谵妄(postoperative delirium,POD)是老年患者术后常见的中枢神经系统并发症,文中评价依达拉奉对髋关节置换术老年患者术后谵妄的作用。方法 2012年6月至2014年3月间在南京军区南京总医院蛛网膜下腔麻醉下行单侧髋关节置换术的老年患者246例,随机数字表法分为依达拉奉组和对照组。依达拉奉组于麻醉诱导前静脉给予依达拉奉30 mg,对照组给予等量等渗盐水。术前1 d及术后1 d采用意识混乱评估法对患者进行评估,记录患者一般临床资料并观察患者住院时间、术后急性肺栓塞、心肌梗死、脑梗死及POD发生率;于术前1 d及术后1 d测定血浆丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、神经原特异性烯醇化酶(neuron-specific enolase,NSE)及S100β蛋白(S100β)表达水平。结果 2组患者住院时间与围术期急性肺栓塞、心肌梗死及脑梗死发生率比较结果差异无统计学意义(P>0.05);依达拉奉组POD发生率明显低于对照组(17.7%vs 30.3%,P<0.05)。2组患者术前血浆MDA、SOD、NSE及S100β比较差异无统计学意义(P>0.05)。依达拉奉组术后1 d血浆MDA及NSE均明显低于对照组,分别为[(2.2±0.5)nmol/L vs(3.6±0.7)nmol/L,P<0.05]和[(6.3±2.2)μg/L vs(8.6±2.8)μg/L,P<0.05]。结论依达拉奉可降低髋关节置换术老年患者POD的发生率,在临床应用中具有促进神经功能康复的作用。

Objective To evaluate the effects of edaravone on postoperative delirium in aged patients following total hip-replacement surgery. Methods Two hundred and forty-six patients undergoing unilateral hip replacement surgery were randomly divided into edaravone group and control group. Patients in the edaravone group were intravenous injected with edaravone 30 mg before anesthesia induction,whereas patients in the control group received the same volume of saline solution. On preoperative day 1 and postoperative day1,confusion assessment was applied to evaluate the consciousness of patients. The length of hospital stay,incidence of myocardial infarction,stroke,pulmonary embolism,pneumonia and transfusion volume were also recorded. Also,the levels of plasma malondialdehyde（ MDA） superoxide dismutase（ SOD）,neuron-specific enolase（ NSE） and S100β protein（ S100β） were measured on the preoperative and postoperative day 1. Results There was no difference in the length of hospital stay,the incidence of perioperative acute pulmonary embolism,myocardial infarction and stroke（ P〈0. 05）. POD was significantly lower in the edaravone group than the control group（ P〈0. 05）. Plasma levels of MDA,SOD,NSE and S100β were comparable between the two groups（ P〈0. 05）. On the postoperative day 1,plasma levels of MDA and NSE were significantly lower in the edaravone group than the control group（ P〈0. 05）. Conclusion Edaravone can reduce the incidence of POD in aged patients following total hip-replacement surgery.