亚甲蓝对老年非心脏手术患者术后认知功能障碍及术后谵妄的影响

Effect of methylene blue on postoperative cognitive dysfunction and postoperative delirium in elderly patients undergoing non-cardiac surgery

目的评价亚甲蓝预防老年非心脏手术患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)及术后谵妄(postoperative delirium,POD)的安全性及有效性。方法选取2021年9月至2022年7月在温州市人民医院进行全身麻醉下非心脏手术的240名老年患者,采用随机数字表法分为亚甲蓝组(n=120)和对照组(n=120)。亚甲蓝组患者在插管后静脉输注2mg/kg的亚甲蓝,对照组输注等量生理盐水。使用简易精神状态量表(mini-mental state examination,MMSE)和蒙特利尔认知评估(Montreal cognitive assessment,MoCA)评估两组的POCD发病率。POD的诊断与评估则采用意识模糊评估量表(confusion assessment method,CAM)及谵妄评定量表-98修订版(delirium rating scale,DRS-R-98)。比较两组患者术前和术后24h中枢神经特异蛋白(S100 calcium-binding proteinβ,S100-β)、超氧化物歧化酶(superoxide dismutase,SOD)、神经元特异性烯醇化酶(neuron specific enolase,NSE)和同型半胱氨酸(homocysteine,Hcy)水平。结果亚甲蓝组的POCD发病率显著低于对照组(P<0.05)。术前1d和术后7d,两组MMSE和Mo CA评分比较,差异均无统计学意义(P>0.05),亚甲蓝组的POD发病率显著低于对照组(P<0.05),两组POD亚型情况比较,差异无统计学意义(P>0.05)。亚甲蓝组的DRS-R-98得分显著低于对照组(P<0.05);术前两组患者血清中S100β、NSE、SOD和Hcy水平比较,差异均无统计学意义(P>0.05)。亚甲蓝组术后24h血清中的S-100β和NSE水平显著低于对照组(P<0.05),血清SOD和Hcy水平比较,差异均无统计学意义(P>0.05)。结论术中输注亚甲蓝可降低非心脏手术老年患者POCD和POD的发生率,可用于临床普及应用。

Objective To evaluate the safety and efficacy of methylene blue for the prevention of postoperative cognitive dysfunction(POCD)and postoperative delirium(POD)in elderly non-cardiac surgery patients.Method A total of 240 elderly patients who underwent non-cardiac surgery under general anaesthesia in Wenzhou People’s Hospital from September 2021 to July 2022 were selected and divided into the methylene blue group(n=120)and the control group(n=120)according to the random number table method.Patients in the methylene blue group were infused with 2mg/kg of methylene blue intravenously after intubation,and the control group was infused with an equal amount of saline.The incidence of POCD was assessed using the mini-mental state examination(MMSE)and the Montreal cognitive assessment(MoCA).The diagnosis and assessment of POD were performed using the confusion assessment method(CAM)and the delirium rating scale-98-revised(DRS-R-98).The levels of S100 calcium-binding proteinβ(S100-β),superoxide dismutase(SOD),neuron specific enolase(NSE)and homocysteine(Hcy)were compared between the two groups before and 24 hours after surgery.Results The incidence of POCD in the methylene blue group was significantly lower than that in the control group(P<0.05).The MMSE and MoCA scores of the two groups were not statistically significant when compared with those of the preoperative 1 days and postoperative 7 days(P>0.05).The incidence rate of POD in the methylene blue group was significantly lower than that of the control group(P<0.05),and the difference between the two groups in terms of the subtypes of POD was not statistically significant when compared with those of the control group(P>0.05).The DRS-R-98 score of the methylene blue group was significantly lower than that of the control group(P<0.05),and the differences in serum levels of S100β,NSE,SOD and Hcy between the two groups were not statistically significant when comparing the two groups before surgery(P>0.05).The serum levels of S-100βand NSE in the methylene blue group were significantly lower than those in the control group at 24 hours postoperatively(P<0.05),and no statistically significant differences were observed when comparing the serum levels of SOD and Hcy(P>0.05).Conclusion Intraoperative infusion of methylene blue reduces the incidence of POCD and POD in elderly patients undergoing non-cardiac surgery and can be used for universal clinical application.