Department of Anesthesiology, The General Hospital of Western Theater Command (QH, QL, FQ, LY, GG), Chengdu, PR China.
Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University (ZL, HN), Xi'an, PR China.
Am J Geriatr Psychiatry. 2021 Dec;29(12):1202-1211. doi: 10.1016/j.jagp.2021.02.043. Epub 2021 Feb 23.
STUDY OBJECTIVES: This study aimed to investigate the effects of repeated preoperative intranasal administration of insulin on the incidence of postoperative delirium (POD) and the levels of serum pro-inflammatory markers in elderly patients undergoing laparoscopic radical gastrointestinal surgery. DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical study. SETTING: General Hospital of Western Theater Command from August 2019 to December 2019. PATIENTS: Ninety elderly patients underwent laparoscopic radical gastrointestinal tumor resections under general anesthesia. INTERVENTIONS: Patients were randomly divided into a control group (0.5 mL saline administered intranasally) or an insulin group (20 U/0.5 mL insulin administered intranasally) for 2 days prior to surgery, with 45 patients in each group. MEASUREMENTS: The incidence of delirium was measured at postoperative day 1 (T2), day 3 (T3), and day 5 (T4) using the Confusion Assessment Method for the intensive care unit (CAM-ICU). Plasma levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were measured at T0 (before insulin or saline administration), T1 (at the end of surgery), T2, T3, and T4 by enzyme-linked immunosorbent assay. MAIN RESULTS: Compared with the control group, the insulin group demonstrated a decreased POD incidence (12.5% vs. 47.5%, p = 0.001) within 5 days after surgery. The incidence of POD was significantly lower in the Ins group than in the Con group at T2 (12.5% vs. 32.5%, p = 0.032) and at T3 (2.5% vs. 20%, p = 0.034). The incidence of POD decreased in both groups over time and was similar at T4 (0% vs 10%, p = 0.116). Compared with the baseline value at T0, serum TNF-α, IL-6 and IL-1β concentrations increased significantly at T1-4 (p <0.05). Compared with the control group at the same time point, the expression levels of TNF-α, IL-6 and IL-1β in group I at T2 and T3 were significantly reduced (p <0.05). The incidence rates of adverse events were similar in the two groups. CONCLUSIONS: Repeated preoperative intranasal administration of insulin prevented the occurrence of delirium after laparoscopic radical gastrointestinal surgery in elderly patients and reduced TNF-α, IL-1β, and IL-6 levels.
研究目的：本研究旨在探讨术前重复经鼻给予胰岛素对老年腹腔镜胃肠根治术后谵妄（POD）发生率及血清促炎标志物水平的影响。
设计：前瞻性、随机、双盲、安慰剂对照的临床研究。
地点：西部战区总医院，2019 年 8 月至 2019 年 12 月。
患者：90 例行全身麻醉下腹腔镜胃肠肿瘤根治术的老年患者。
干预措施：患者术前 2 天随机分为对照组（0.5ml 生理盐水经鼻给予）或胰岛素组（20U/0.5ml 胰岛素经鼻给予），每组 45 例。
测量：采用重症监护病房意识模糊评估法（CAM-ICU）于术后第 1 天（T2）、第 3 天（T3）和第 5 天（T4）测量谵妄发生率。采用酶联免疫吸附试验于 T0（胰岛素或生理盐水给药前）、T1（手术结束时）、T2、T3 和 T4 测量血浆白细胞介素（IL）-1β、IL-6 和肿瘤坏死因子（TNF）-α水平。
主要结果：与对照组相比，胰岛素组术后 5 天内 POD 发生率降低（12.5%比 47.5%，p=0.001）。T2 时胰岛素组 POD 发生率明显低于对照组（12.5%比 32.5%，p=0.032），T3 时胰岛素组 POD 发生率明显低于对照组（2.5%比 20%，p=0.034）。两组 POD 发生率随时间下降，T4 时相似（0%比 10%，p=0.116）。与 T0 时的基线值相比，T1-4 时血清 TNF-α、IL-6 和 IL-1β 浓度明显升高（p<0.05）。与同一时间点的对照组相比，I 组 T2 和 T3 时 TNF-α、IL-6 和 IL-1β 的表达水平明显降低（p<0.05）。两组不良事件发生率相似。
结论：术前重复经鼻给予胰岛素可预防老年腹腔镜胃肠根治术后谵妄的发生，并降低 TNF-α、IL-1β 和 IL-6 水平。
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022-2-28
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