褪黑素对老年女性患者术后早期认知功能障碍的影响
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摘要
目的探讨褪黑素对老年女性患者术后早期认知功能、睡眠质量和术后疼痛的影响。方法选择我院2017年9月至2018年1月行择期全麻妇科手术的老年患者90例,ASAⅠ～Ⅲ级,随机分为褪黑素组(M组)和安慰剂组(P组)。M组于术前1 d晚8点与术前0.5 h口服褪黑素6 mg,P组给予安慰剂。记录术后第1、3、7天晚7点简易精神状态量表(MMSE)评分;术后第1、第2天晚7点总睡眠时间与视觉模拟(VAS)疼痛评分。结果 2组患者一般资料无统计学差异;2组术前1 d时MMSE评分无统计学差异(P>0.05);与术前1 d比较,术后不同时间点2组MMSE评分明显降低(P <0.05);与P组比较,M组术后不同时间点MMSE评分明显增加(P <0.05);与P组比较,M组术后第1、2天总睡眠时间明显增加(P <0.05);M组术后第1、2天VAS疼痛评分与P组比较无统计学差异(P> 0.05)。结论褪黑素可减少老年患者妇科手术术后早期认知功能障碍发生,增加术后总睡眠时间,但不能改善术后疼痛。
Objective To investigate the effect of melatonin on early postoperative cognitive function,sleep quality,and postoperative pain in elderly female patients. Methods Ninety elderly patients with American Society of AnesthesiologistsⅠtoⅢwere enrolled from September 2017 to January 2018. They were randomly divided into the melatonin group(M group) and placebo group(P group). The M group received 6 mg melatonin at 8:00 pm one day before surgery and half an hour before the surgery,whereas the P group received the placebo. The Mini-Mental State Examination(MMSE) scores on the first,third,and seventh days after surgery were recorded. The total sleep time and visual analog scale(VAS) pain scores on the first and second days were recorded. Results There was no significant difference in the characteristics of the patients. The MMSE scores postoperatively in the two groups were significantly lower than those on the first day before the surgery(P < 0.05). Compared with those in the P group,the MMSE scores in the M group increased significantly at different time points. Compared with that in the P group,the total sleep time in the M group significantly increased on the first and second days after the surgery(P < 0.05). There was no significant difference in the VAS pain scores on the first and second days between the two groups(P > 0.05). Conclusion Melatonin can decrease early postoperative cognitive dysfunction,increase postoperative total sleeping time,but not improve postoperative pain.
Objective To investigate the effect of melatonin on early postoperative cognitive function,sleep quality,and postoperative pain in elderly female patients. Methods Ninety elderly patients with American Society of AnesthesiologistsⅠtoⅢwere enrolled from September 2017 to January 2018. They were randomly divided into the melatonin group(M group) and placebo group(P group). The M group received 6 mg melatonin at 8:00 pm one day before surgery and half an hour before the surgery,whereas the P group received the placebo. The Mini-Mental State Examination(MMSE) scores on the first,third,and seventh days after surgery were recorded. The total sleep time and visual analog scale(VAS) pain scores on the first and second days were recorded. Results There was no significant difference in the characteristics of the patients. The MMSE scores postoperatively in the two groups were significantly lower than those on the first day before the surgery(P < 0.05). Compared with those in the P group,the MMSE scores in the M group increased significantly at different time points. Compared with that in the P group,the total sleep time in the M group significantly increased on the first and second days after the surgery(P < 0.05). There was no significant difference in the VAS pain scores on the first and second days between the two groups(P > 0.05). Conclusion Melatonin can decrease early postoperative cognitive dysfunction,increase postoperative total sleeping time,but not improve postoperative pain.
引文
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[19]WITLOX J,EURELINGS LSM,JONGHE JFMD,et al.Delirium in elderly patients and the risk of postdischarge mortality,institutionalization,and dementia a meta-analysis[J].JAMA,2010,304(4):443-451.DOI:10.1001/jama.2010.1013.
[20]WONGPRAYOON P,GOVITRAPONG P.Melatonin attenuates methamphetamine-induced neuroinflammation through the melatonin receptor in the SH-SY5Y cell line[J].Neurotoxicology,2015,50:122-130.DOI:10.1016/j.neuro.2015.08.008.
[21]TERRANDO N,MONACO C,MA DQ,et al.Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline[J].Proc Natl Acad Sci USA,2010,107(47):20518-20522.DOI:10.1073/pnas.1014557107.
[22]HARDELAND R,MADRID JA,TAN DX,et al.Melatonin,the circadian multioscillator system and health:the need for detailed analyses of peripheral melatonin signaling[J].J Pineal Res,2012,52(2):139-166.DOI:10.1111/j.1600-079x.2011.00934.x.
[23]ALGHAMDI BS.The neuroprotective role of melatonin in neurological disorders[J].J NeurosciRes,2018,96(7):1136-1149.DOI:10.1002/jnr.24220.
[24]WRIGHT KP,HULL JT,HUGHES RJ,et al.Sleep and wakefulness out of phase with internal biological time impairs learning in humans[J].J Cogn Neurosci,2006,18(4):508-521.DOI:10.1162/jocn.2006.18.4.508.
[25]DANILOV A,KURGANOVA J.Melatonin in chronic pain syndromes[J].Pain Ther,2016,5(1):1-17.DOI:10.1007/s40122-016-0049-y.
[26]SHAVALI S,HO B,GOVITRAPONG P,et al.Melatonin exerts its analgesic actions not by binding to opioid receptor subtypes but by increasing the release of beta-endorphin an endogenous opioid[J].Brain Res Bullet,2005,64(6):471-479.DOI:10.1016/j.brainresbull.2004.09.008.
[2]STEINMETZ J,CHRISTENSEN KB,LUND T,et al.Long-term consequences of postoperative cognitive dysfunction[J].Anesthesiology,2009,110(3):548-555.DOI:10.1097/ALN.0b013e318195b569.
[3]MOLLER JT,CLUITMANS P,RASMUSSEN LS,et al.Long-term postoperative cognitive dysfunction in the elderly:ISPOCD1 study[J].Lancet,1998,351(9106):857-861.DOI:10.1016/S0140-6736(97)07382-0.
[4]HUANG HW,ZHENG BL,JIANG L,et al.Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment:which might be a more promising strategy for ICU sleep deprivation?[J].Crit Care,2015,19:124.DOI:10.1186/s13054-015-0842-8.
[5]ZUROWSKI D NL,MACHOWSKA A.Exogenous melatonin abolishes mechanical allodynia but notthermal hyperalgesia in neuropathic pain.The role of the opioid system and benzodiazepine-gabaergic mechanism[J].J Physiol Pharmacol,2012,63(6):641-647.DOI:10.1152/advan.00073.2012.
[6]FORBES D,JANSEN S L,DUNCAN V,et al.Melatonin for cognitive impairment(Protocol)[J].Cochrane Database Syst Rev,2009,25(1):CD003802.DOI:10.1002/14651858.CD003802.pub3.
[7]WU Y,WANG JW,WU AS,et al.Do fluctuations in endogenous melatonin levels predict the occurrence of postoperative cognitive dysfunction(POCD)?[J].Int J Neurosci,2014,124(11):787-791.DOI:10.3109/00207454.2014.882919.
[8]BORAZAN H,TUNCER S,YALCIN N,et al.Effects of preoperative oral melatonin medication on postoperative analgesia,sleep quality,and sedation in patients undergoing elective prostatectomy:a randomized clinical trial[J].J Anesth,2010,24(2):155-160.DOI:10.1007/s00540-010-0891-8.
[9]HANSEN MV,MADSEN MT,ANDERSEN LT,et al.Effect of melatonin on cognitive function and sleep in relation to breast cancer surgery:a randomized,double-blind,placebo-controlled trial[J].Int JBreast Cancer,2014,2014:1-9.DOI:10.1155/2014/416531.
[10]FAN YX,YUAN L,JI MH,et al.The effect of melatonin on early postoperative cognitive decline in elderly patients undergoing hip arthroplasty:a randomized controlled trial[J].J Clin Anesth,2017,39:77-81.DOI:10.1016/j.jclinane.2017.03.023.
[11]MONK TG,WELDON BC,GARVAN CW,et al.Predictors of cognitive dysfunction after major noncardiac surgery[J].Anesthesiology,2008,108(1):18-30.DOI:10.1097/01.anes.0000296071.19434.1e.
[12]LYMAN M,LLOYD DG,JI XM,et al.Neuroinflammation:the role and consequences[J].Neurosci Res,2014,79:1-12.DOI:10.1016/j.neures.2013.10.004.
[13]HARTEN AEV,SCHEEREN TWL,ABSALOM AR.A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia[J].Anaesthesia,2012,67(3):280-293.DOI:10.1111/j.1365-2044.2011.07008.x.
[14]KRENK L,RASMUSSEN LS,KEHLET H.New insights into the pathophysiology of postoperative cognitive dysfunction[J].Acta Anaesthesiol Scand,2010,54(8):951-956.DOI:10.1111/j.1399-6576.2010.02268.x.
[15]FENG L,WU HW,SONG GQ,et al.Chronical sleep interruption-induced cognitive decline assessed by a metabolomics method[J].Behav Brain Res,2016,302:60-68.DOI:10.1016/j.bbr.2015.12.039.
[16]WALKER MP.Cognitive consequences of sleep and sleep loss[J].Sleep Med,2008,9(Suppl1):S29-S34.DOI:10.1016/S1389-9457(08)70014-5.
[17]章放香,宁俊平,邱冰,等.不同麻醉老年患者术后认知功能障碍发生的比较[J].中华麻醉学杂志,2013,33(2):188-190.DOI:10.3760/cma.j.issn.0254-1416.2013.02.014.
[18]VACAS S,DEGOS V,MAZE M.Fragmented sleep enhances postoperative neuroinflammation but not cognitive dysfunction[J].Anesth Analg,2017,124(1):270-276.DOI:10.1213/ANE.0000000000001675.
[19]WITLOX J,EURELINGS LSM,JONGHE JFMD,et al.Delirium in elderly patients and the risk of postdischarge mortality,institutionalization,and dementia a meta-analysis[J].JAMA,2010,304(4):443-451.DOI:10.1001/jama.2010.1013.
[20]WONGPRAYOON P,GOVITRAPONG P.Melatonin attenuates methamphetamine-induced neuroinflammation through the melatonin receptor in the SH-SY5Y cell line[J].Neurotoxicology,2015,50:122-130.DOI:10.1016/j.neuro.2015.08.008.
[21]TERRANDO N,MONACO C,MA DQ,et al.Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline[J].Proc Natl Acad Sci USA,2010,107(47):20518-20522.DOI:10.1073/pnas.1014557107.
[22]HARDELAND R,MADRID JA,TAN DX,et al.Melatonin,the circadian multioscillator system and health:the need for detailed analyses of peripheral melatonin signaling[J].J Pineal Res,2012,52(2):139-166.DOI:10.1111/j.1600-079x.2011.00934.x.
[23]ALGHAMDI BS.The neuroprotective role of melatonin in neurological disorders[J].J NeurosciRes,2018,96(7):1136-1149.DOI:10.1002/jnr.24220.
[24]WRIGHT KP,HULL JT,HUGHES RJ,et al.Sleep and wakefulness out of phase with internal biological time impairs learning in humans[J].J Cogn Neurosci,2006,18(4):508-521.DOI:10.1162/jocn.2006.18.4.508.
[25]DANILOV A,KURGANOVA J.Melatonin in chronic pain syndromes[J].Pain Ther,2016,5(1):1-17.DOI:10.1007/s40122-016-0049-y.
[26]SHAVALI S,HO B,GOVITRAPONG P,et al.Melatonin exerts its analgesic actions not by binding to opioid receptor subtypes but by increasing the release of beta-endorphin an endogenous opioid[J].Brain Res Bullet,2005,64(6):471-479.DOI:10.1016/j.brainresbull.2004.09.008.