肢体远隔缺血预处理对肺癌根治术老年患者术后谵妄发生的影响

Effects of remote ischemic preconditioning on occurrence of postoperative delirium in elderly patients undergoing radical mastectomy

目的评价肢体远隔缺血预处理(RIPC)对肺癌根治术老年患者术后谵妄发生的影响。方法择期行肺癌根治术老年患者60例,年龄65~78岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=30):对照组(C组)和RIPC组。RIPC组于麻醉诱导后5 min于右上肢上臂采用测压袖带给予3个循环的5 min缺血及5 min再灌注处理;C组将袖带绑于右上肢,但不进行充气及放气操作。分别于麻醉诱导前10 min(T0)、手术结束1、12、24、48和72 h(T1-5)时抽取颈内静脉球部血样,检测血清S-100β蛋白和神经元特异性烯醇化酶(NSE)的浓度;采用ICU意识障碍评估法(CAM-ICU)评估术后72 h谵妄发生情况。记录低血压、窦性心动过缓、再次气管插管的发生情况。分别于术后1和2 d时,采用康复质量评分量表-15(QoR-15)评估术后早期康复质量。结果与C组比较,RIPC组患者T1-5时血清S-100β蛋白和NSE浓度及术后72 h谵妄发生率降低,术后1和2 d时QoR-15评分升高(P<0.05)。2组间谵妄持续时间、窦性心动过缓、低血压及再次气管插管发生率差异均无统计学意义(P>0.05)。结论RIPC可降低肺癌根治术老年患者术后谵妄的发生,有利于患者术后早期康复。

Objective To evaluate the effects of remote ischemic preconditioning(RIPC)on occurrence of postoperative delirium in elderly patients undergoing radical mastectomy.Methods Sixty elderly patients,aged 65-78 yr,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective radical mastectomy,were allocated into 2 groups(n=30 each)using a random number table method:control group(group C)and RIPC group.Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the upper arm of the right upper arm served as RIPC treatment at 5 min after induction of anesthesia in RIPC group.The blood pressure cuff was only placed on the upper arm of the right upper arm without inflation and deflation in group C.Jugular bulb venous blood samples were obtained at 10 min before anesthesia induction(T0)and 1,12,24,48 and 72 h after the end of operation(T1-5)for determination of S-100βprotein and neuron-specific enolase(NSE)concentrations in serum.The occurrence of delirium within 72 h after operation was estimated using Confusion Assessment Method for the Intensive Care Unit.The occurrence of hypotension,sinus bradycardia and reintubation was recorded.The Quality of Recovery-15(QoR-15)was used to evaluate the early postoperative quality of recovery at 1 and 2 days after operation.Results Compared with group C,the concentrations of S-100βprotein and NSE in serum and incidence of delirium within 72 h after operation were significantly decreased at T1-T5,and the Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group RIPC(P<0.05).There was no significant difference in the duration of delirium or incidence of hypotension,sinus bradycardia and reintubation between the two groups(P>0.05).Conclusion RIPC can decrease the development of postoperative delirium and is helpful for the early postoperative recovery of elderly patients undergoing radical mastectomy.