Department of Surgery, Nara Medical University, Kashihara-shi, Nara, Japan.
PLoS One. 2020 Nov 2;15(11):e0241673. doi: 10.1371/journal.pone.0241673. eCollection 2020.
Postoperative delirium was reported to be associated with increased postoperative mortality after liver resection. Therefore, it is crucial to prevent postoperative delirium in such cases. Ramelteon, an agonist of melatonin receptor has been suggested to be useful for preventing delirium. The aim of this study was to examine whether ramelteon is effective at preventing delirium after elective liver resection.
The cases of patients who underwent liver resection at Nara Medical University (Nara, Japan) between January 2014 and August 2018 were analyzed. During the period from January 2017 to August 2018, ramelteon was prospectively administered to patients who underwent liver resection [8 mg/day on the day before surgery and on postoperative days 1 to 3] (ramelteon group), whereas ramelteon was not administered during the period from January 2014 to December 2016 (control group). The perioperative outcomes of the two groups were compared.
There were 120 patients in the ramelteon group and 186 patients in the control group. No significant intergroup differences in background factors, including age, gender, and preoperative serological laboratory data, were detected. The incidence of postoperative delirium was significantly lower in the ramelteon group (5.8% vs. 15.1%, P = 0.035). Multivariate analysis revealed that being aged ≥75 (P = 0.002), being male (P = 0.020), cardiovascular disease (P = 0.023), blood loss ≥1000ml (P = 0.001) and the absence of ramelteon treatment (P = 0.046) were independent risk factors for postoperative delirium.
The administration of ramelteon might reduce the risk of postoperative delirium after elective liver resection.
术后谵妄与肝切除术后死亡率增加有关。因此，预防此类患者术后谵妄至关重要。褪黑素受体激动剂雷美替胺已被证明可用于预防谵妄。本研究旨在探讨雷美替胺是否能有效预防择期肝切除术后的谵妄。
分析了 2014 年 1 月至 2018 年 8 月期间在奈良医科大学（奈良，日本）接受肝切除术的患者病例。在 2017 年 1 月至 2018 年 8 月期间，雷美替胺被前瞻性地用于接受肝切除术的患者（手术前一天和术后第 1 至 3 天每天 8mg）（雷美替胺组），而在 2014 年 1 月至 2016 年 12 月期间未给予雷美替胺（对照组）。比较两组围手术期结局。
雷美替胺组有 120 例患者，对照组有 186 例患者。两组患者在年龄、性别和术前血清学实验室数据等背景因素方面无显著差异。雷美替胺组术后谵妄发生率明显较低（5.8% vs. 15.1%，P=0.035）。多变量分析显示，年龄≥75 岁（P=0.002）、男性（P=0.020）、心血管疾病（P=0.023）、出血量≥1000ml（P=0.001）和未使用雷美替胺治疗（P=0.046）是术后谵妄的独立危险因素。
雷美替胺的应用可能降低择期肝切除术后谵妄的风险。
