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褪黑素对具有多因素术后谵妄发生风险的老年患者的预防作用:一项随机对照研究

Performance of Melatonin as Prophylaxis in Geriatric Patients with Multifactorial Risk for Postoperative Delirium Development: A Randomized Comparative Study.

作者信息

Mohamed Sherif Abdullah, Rady Ashraf, Youssry Mona, Abdelaziz Mohamed Mennatallah Reda, Gamal Medhat

机构信息

Department of Anaesthesia, Cairo University Faculty of Medicine, Cairo, Egypt.

Department of Internal Medicine, Cairo University Faculty of Medicine, Cairo, Egypt.

出版信息

Turk J Anaesthesiol Reanim. 2022 Jun;50(3):178-186. doi: 10.5152/TJAR.2022.20017.

Abstract

OBJECTIVE

Postoperative delirium is the worst patient outcome. Elderly patients undergoing orthopaedic procedures under general anaes- thesia are highly liable to experience delirium. Several studies supported melatonin use for the prevention of delirium. This work evaluated the prophylactic efficiency of melatonin for postoperative delirium in patients with multifactorial risk for developing delirium as elderly undergoing orthopaedic trauma surgery under general anaesthesia.

METHODS

This double-blinded prospective randomized comparative study was conducted on 80 elderly patients subjected to orthopaedic interventions under general anaesthesia. Patients were randomized into group M (Melatonin group) and group NM (Non-melatonin group). Group M received 5 mg melatonin while group NM received placebo. The study drugs were given preoperatively and for the first 3 postop- erative days. For the incidence of delirium, patients were evaluated using the Abbreviated Mental Test. The Pain Assessment in Advanced Dementia, sedation scores, and changes in hemodynamics were recorded.

RESULTS

The incidence of delirium was significantly lower postoperatively in M group (25%) relative to NM group (52.5%) (P <ƒ .001, OR=2.3. 95% CI=-0.44,+1.23). Abbreviated Mental Test scores at postanaesthesia care unit and day 0 showed a highly significant dif- ferences. However, Abbreviated Mental Test scores had no significant difference within the 3 postoperative days. Heart rate was significantly lower in M group after 50 minutes from the start of surgery. Mean blood pressure, Pain Assessment in Advanced Dementia, and sedation scores showed insignificant differences.

CONCLUSION

Perioperative melatonin treatment could reduce the incidence of postoperative delirium in the studied population, and it could be considered a prophylactic medication.

摘要

目的

术后谵妄是最糟糕的患者结局。接受全身麻醉的骨科手术的老年患者极易发生谵妄。多项研究支持使用褪黑素预防谵妄。本研究评估了褪黑素对具有多因素谵妄风险的患者(如接受全身麻醉的骨科创伤手术的老年患者)术后谵妄的预防效果。

方法

本双盲前瞻性随机对照研究对80例接受全身麻醉下骨科手术的老年患者进行。患者被随机分为M组(褪黑素组)和NM组(非褪黑素组)。M组接受5mg褪黑素,而NM组接受安慰剂。研究药物在术前及术后的前3天给药。对于谵妄的发生率,使用简易精神状态检查表对患者进行评估。记录晚期痴呆患者的疼痛评估、镇静评分和血流动力学变化。

结果

M组术后谵妄的发生率(25%)显著低于NM组(52.5%)(P<0.001,OR=2.3,95%CI=-0.44,+1.23)。麻醉后护理单元和术后第0天的简易精神状态检查表评分显示出高度显著差异。然而,术后3天内简易精神状态检查表评分无显著差异。手术开始50分钟后,M组的心率显著较低。平均血压、晚期痴呆患者的疼痛评估和镇静评分显示无显著差异。

结论

围手术期使用褪黑素治疗可降低研究人群术后谵妄的发生率,可将其视为一种预防性药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13b8/9361198/35fef68cc625/tjar-50-3-178_f001.jpg

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