■术后谵妄(POD)是与瓣膜置换相关的常见神经系统并发症。术前睡眠障碍是POD发展的危险因素,鼻胰岛素调节睡眠-觉醒周期。这项研究调查了鼻内胰岛素预处理对风湿性心脏病瓣膜置换术患者术前睡眠质量和降低POD的有益影响。
■这个前景,单中心,随机对照试验(RCT)纳入76例18~65岁接受体外循环瓣膜手术的成年患者,这些患者在手术前两天被随机分配接受鼻内胰岛素或生理盐水干预.POD发生率为术后第1天(T3),2(T4),3(T5)。在第一次干预之前(T0),手术前1d(T1),在手术当天(T2)麻醉前,评估睡眠质量并测定血清皮质醇浓度.在T1和T2,记录由前一天晚上的睡眠监测手表监测的睡眠质量相关指标。
■与生理盐水组相比,手术后3天,胰岛素组POD发生率明显降低;深度睡眠明显增加,REM睡眠,深度睡眠连续性,和总睡眠质量评分在T1和T2;和显着降低血清皮质醇浓度,PSQI量表,轻度睡眠比例,在T1和T2清醒。
■每天两次给予20U鼻内胰岛素,从术前2天到手术当天麻醉前10分钟,能显著改善风湿性心脏病瓣膜置换术患者术前睡眠质量,降低POD发生率。
■本研究已在中国临床试验注册中心注册(www。chictr.org.cn,具有唯一标识符ChiCTR2100048515;2021年7月9日)。
UNASSIGNED: Postoperative delirium (POD) is a common neurological complication associated with valve replacement. Preoperative sleep disturbance is a risk factor for POD development, and nasal insulin modulates the sleep-wake cycle. This study investigated the beneficial effects of intranasal insulin pretreatment on preoperative sleep quality and reducing POD in patients undergoing valve replacement for rheumatic heart disease.
UNASSIGNED: This prospective, single-center, randomized controlled trial (RCT) included 76 adult patients aged 18-65 years undergoing valve surgery with cardiopulmonary bypass who were randomly allocated to receive intranasal insulin or normal saline interventions two days before surgery. POD incidence was on postoperative days 1 (T3), 2 (T4), and 3 (T5). Before the first intervention (T0), 1 d before surgery (T1), and before anesthesia on the day of surgery (T2), sleep quality was assessed and serum cortisol concentrations were measured. At T1 and T2, sleep quality related indicators monitored by sleep monitoring watches from the previous night were recorded.
UNASSIGNED: Compared with the normal saline group, 3 days after surgery, the insulin group showed a significantly reduced incidence of POD; significantly increased deep sleep, REM sleep, deep sleep continuity, and total sleep quality scores at T1 and T2; and significantly reduced serum cortisol concentration, PSQI scale, light sleep ratio, and wakefulness at T1 and T2.
UNASSIGNED: The administration of 20 U of intranasal insulin twice daily, from 2 days preoperatively until 10 minutes preanesthesia on the day of surgery, can improved preoperative sleep quality significantly and reduced POD incidence in patients with rheumatic heart disease undergoing valve replacement.
UNASSIGNED: This study was registered with the Chinese Clinical Trial Registry (www.chictr.org.cn, with the unique identifier ChiCTR2100048515; July 9, 2021).