Department of Anesthesiology, The Third Hospital of Hebei Medical University, No 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
Department of Respiration, Tianjin Institute of Respiratory Diseases, Tianjin Haihe Hospital, Tianjin Medical University, Tianjin, 300350, People's Republic of China.
J Neuroinflammation. 2017 Nov 14;14(1):221. doi: 10.1186/s12974-017-0999-y.
Postoperative delirium (POD) is a common disorder in the elderly patients, and neuroinflammation is the possible underlying mechanism. This study is designed to determine whether or not hypertonic saline (HS) pre-injection can alleviate POD in aged patients.
This prospective study recruited 120 geriatric patients who underwent hip surgery. The patients were randomly divided into two groups: control group (NS group) and HS group. Patients in the NS group were pre-injected with 4 mL/kg isotonic saline, and those in the HS group were pre-injected with 4 mL/kg 7.5% HS. All 120 patients were then subjected to general anesthesia. Blood samples were extracted to detect the concentration of inflammatory factors, namely, IL-1β, IL-6, IL-10, and TNF-α, and the nerve injury factor S100β. Flow cytometry was used to detect the number of monocytes in peripheral venous blood and evaluate the relationship of inflammation to delirium. The nursing delirium screening scale (Nu-DESC) was used to determine cognitive function 1 to 3 days postoperatively.
Analysis using random-effect multivariable logistic regression indicated that HS administration before anesthesia was associated with a low risk of POD (odds ratio [OR], 0.13; 95% CI, 0.04 to 0.41; P = 0.001) and few CD14 + CD16+ monocytes (β = - 0.61; 95% CI, - 0.74 to - 0.48; P = 0.000) the following day. When the association between HS and delirium was controlled for CD14 + CD16+ monocytes, the effect size became nonsignificant (odds ratio [OR], 0.86; 95% CI, 0.14 to 5.33; P = 0.874). TNF-α was significantly associated with POD (odds ratio [OR], 1.10; 95% CI, 1.05 to 1.16; P = 0.000). However, IL-1β, IL-6, IL-10, and S100β were not significantly related to POD.
HS can alleviate POD in geriatric patients and may inhibit the secretion of inflammatory factors by monocytes.
术后谵妄（POD）是老年患者中常见的疾病，神经炎症是其可能的潜在机制。本研究旨在确定高渗盐水（HS）预先注射是否可以减轻老年患者的 POD。
这项前瞻性研究招募了 120 名接受髋关节手术的老年患者。患者随机分为两组：对照组（NS 组）和 HS 组。NS 组患者预先注射 4mL/kg 等渗盐水，HS 组患者预先注射 4mL/kg 7.5% HS。所有 120 名患者均接受全身麻醉。抽取血样检测炎症因子（IL-1β、IL-6、IL-10 和 TNF-α）和神经损伤因子 S100β的浓度，流式细胞术检测外周静脉血中单核细胞的数量，并评估炎症与谵妄的关系。使用护理谵妄筛查量表（Nu-DESC）在术后 1 至 3 天评估认知功能。
采用随机效应多变量逻辑回归分析表明，麻醉前给予 HS 与 POD 风险较低相关（优势比 [OR]，0.13；95%CI，0.04 至 0.41；P=0.001），且第二天 CD14+CD16+单核细胞数量较少（β=-0.61；95%CI，-0.74 至-0.48；P=0.000）。当控制 CD14+CD16+单核细胞后，HS 与谵妄之间的关联变得无统计学意义（OR，0.86；95%CI，0.14 至 5.33；P=0.874）。TNF-α 与 POD 显著相关（OR，1.10；95%CI，1.05 至 1.16；P=0.000）。然而，IL-1β、IL-6、IL-10 和 S100β 与 POD 无显著相关性。
HS 可减轻老年患者的 POD，并可能抑制单核细胞炎症因子的分泌。
