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| 围术期胰岛素鼻内给药对老年髋部骨折患者术后谵妄的影响 |
| Effect of perioperative intranasal insulin administration on postoperative delirium in elderly patients undergoing hip fractures surgery |
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| DOI：10.12089/jca.2026.03.001 |
| 中文关键词: 胰岛素 鼻内给药 老年 髋部骨折 术后谵妄 睡眠质量 |
| 英文关键词: Insulin Intranasal administration Aged Hip fracture Postoperative delirium Sleep quality |
| 基金项目:蚌埠医科大学自然科学重点项目（2023byzd214） |
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| 中文摘要: |
目的： 探讨围术期多次胰岛素鼻内给药对老年髋部骨折患者术后谵妄（POD）的影响。
方法： 选择全麻下接受髋部骨折手术的老年患者，年龄≥65岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ—Ⅲ级。将患者随机分为两组：对照组（C组）和胰岛素组（I组）。术前2 d至术后2 d，每天2次对患者进行鼻内给药，C组每次鼻内给予生理盐水0.5 ml，I组每次鼻内给予胰岛素注射液0.5 ml（20 U）。主要指标为术后5 d内POD发生率。次要指标包括术后1、3、5 d POD发生率，术前3 d、术前1 d、手术当日和术后2 d理查兹-坎贝尔睡眠问卷（RCSQ）评分、总睡眠时间、浅睡眠、深睡眠和快速眼动（REM）睡眠比例，术前2 d和术后1、3 d晨起空腹血糖，术后1、3、5 d 静息时VAS疼痛评分，镇痛泵有效按压次数、镇痛泵总按压次数和补救镇痛率。不良反应包括低血糖或其他严重不良事件。
结果： 共纳入患者86例，每组43例。与C组比较，I组术后1、3 d、术后5 d内POD发生率明显降低，术前1 d、手术当日、术后2 d RCSQ评分明显升高，总睡眠时间明显延长，浅睡眠比例明显降低，深睡眠和REM睡眠比例明显升高（P<0.05）。
结论： 围术期胰岛素鼻内给药可降低老年髋部骨折患者POD发生率，并提高患者围术期睡眠质量。 |
| 英文摘要: |
Objective: To investigate the effect of perioperative repeated intranasal insulin administration on postoperative delirium (POD) in elderly patients undergoing hip fracture surgery.
Methods: Elderly patients aged ≥ 65 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ - Ⅲ, scheduled for hip fracture surgery under general anesthesia were enrolled. Patients were randomly assigned to two groups: the control group (group C) and the insulin group (group I). From 2 days preoperatively to 2 days postoperatively, patients received intranasal treatment twice daily. Group C received normal saline 0.5 ml per dose, while group I received insulin injection 0.5 ml (20 U) per dose. The primary outcome was the incidence of POD within 5 days postoperatively. Secondary outcomes included the incidonce of POD on 1 day, 3, and 5 days postoperatively, Richards-Campbell sleep questionnaire (RCSQ) scores, the total sleep time, and the proportion of light sleep, deep sleep, and rapid eye movement (REM) sleep relative to total sleep time on 3 days and 1 day preoperatively, the day of surgery, and on 2 days postoperatively, fasting blood glucose in the morning on 2 days preoperatively, 1 day and 3 days postoperatively, VAS pain scores at rest on 1 day, 3, and 5 days postoperatively, the number of effective patient-controlled analgesia pump presses, total pump presses, and incidences of requiring rescue analgesia. Adverse reactions included hypoglycemia or other serious adverse events.
Results: Eighty-six patients were enrolled, 43 patients in each group. Compared with group C, the incidences of POD on 1 day and 3 days postoperatively, within 5 days postoperatively were significantly decreased, RCSQ scores were significantly increased on 1 day preoperatively, the day of surgery, and on 2 days postoperatively, the total sleep time was significantly prolonged, the proportion of light sleep was significantly decreased, and the proportions of deep sleep and REM sleep were significantly increased (P < 0.05).
Conclusion: Perioperative intranasal insulin administration can reduce the incidence of POD and improve perioperative sleep quality in elderly patients with hip fracture surgery. |
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