麻醉方法与老年膝关节置换患者血清褪黑素质量浓度和苏醒期谵妄的关系

Correlation of anesthesia methods with serum melatonin mass concentration and delirium during recovery in elderly patients undergoing knee arthroplasty

背景:老年手术患者术后苏醒期谵妄的发生率较高,机制尚不明确,研究其发生机制,并设法减少老年患者苏醒期谵妄的发生是麻醉医生面临的急需解决的重要问题。目的:探讨老年膝关节置换患者围术期褪黑素血清质量浓度与苏醒期谵妄发生的关系,并比较不同麻醉方式对褪黑素血清浓度的影响。方法:择期行膝关节置换患者随机分为2组,即全身麻醉组和全身麻醉联合股神经阻滞麻醉组(联合麻醉组)。所有患者对治疗及试验方案知情同意,且得到医院伦理委员会批准。分别检测患者进入手术室实施麻醉前和手术结束后停止输注一切麻醉药物后静脉血中褪黑素的血清质量浓度。在拔除喉罩即刻,根据护理谵妄筛查量表进行苏醒期谵妄发生情况评估。结果与结论:①联合麻醉组与全身麻醉组比较苏醒期谵妄发生率差异无显著性意义(P>0.05),但是联合麻醉组苏醒期谵妄评分低于全身麻醉组,差异有显著性意义(P<0.05);②联合麻醉组术后褪黑素质量浓度与术前差异无显著性意义(P>0.05);全身麻醉组术后褪黑素质量浓度较术前明显下降,差异有显著性意义(P<0.05);③联合麻醉组术前术后褪黑素质量浓度差值显著小于全身麻醉组,差异有显著性意义(P<0.05);④Spearman相关分析结果表明,苏醒期谵妄评分与术后褪黑素质量浓度呈负相关(r=-0.429,P<0.05);苏醒期谵妄评分与术前术后褪黑素质量浓度差值呈正相关(r=0.741,P<0.05);⑤提示全身麻醉联合股神经阻滞麻醉能够显著降低老年膝关节置换患者的苏醒期谵妄评分,其机制可能与抑制褪黑素血清质量浓度下降有关。

BACKGROUND: The incidence of postoperative delirium in senile patients is high, and the mechanism is still unclear. To study the mechanism and try to reduce the occurrence of postoperative delirium in senile patients is an important problem for anesthesiologists to solve. OBJECTIVE: To investigate the relationship between serum melatonin concentration and delirium in recovery stage in elderly patients undergoing knee arthroplasty, and to compare the effects of different anesthesia on serum melatonin concentration. METHODS: Patients undergoing knee replacement were randomly divided into two groups: general anesthesia group and general anesthesia + femoral nerve block anesthesia group. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. The serum concentration of melatonin was measured before and at the end of operation when all anesthetic drugs were infused. The occurrence of recovery delirium was evaluated according to the nursing delirium screening scale immediately after removal of the larynx mask. RESULTS AND CONCLUSION:(1) There was no significant difference in the incidence of delirium between general anesthesia + femoral nerve block anesthesia group and general anesthesia group (P > 0.05), but the score of delirium in general anesthesia + femoral nerve block anesthesia group was significantly lower than that in general anesthesia group (P < 0.05).(2) There was no significant difference in melatonin mass concentration between pre-and post-operation in general anesthesia + femoral nerve block anesthesia group (P > 0.05). Melatonin mass concentration was significantly decreased after operation compared with that before operation in the general anesthesia group (P < 0.05).(3) Difference of melatonin mass concentration was significantly less in the general anesthesia + femoral nerve block anesthesia group than in the general anesthesia group before and after operation (P < 0.05).(4) Spearman correlation analysis demonstrated that there was a negative correlation between delirium score during recovery stage and postoperative melatonin mass concentration (r=-0.429, P < 0.05). There was a positive correlation between delirium score during recovery stage and the difference of melatonin mass concentration (r=0.741, P < 0.05).(5) General anesthesia combined with femoral nerve block anesthesia could remarkably decrease delirium score during recovery stage in elderly patients undergoing knee arthroplasty. The mechanism may be related to inhibition of the reduction of serum melatonin mass concentration.