Effect Of Nimodipine On Postoperative Delirium In Elderly With Lacunar Infarction

Objective:To evaluate the effect of nimodipine on postoperative delirium（POD）in elderly patients with lacunar infarction.Methods:Sixty patients with lacunar infarction of both sexes,aged 65-80 year,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective spinal surgery under general anesthesia,were divided into 2 groups（n=30 each）using a random number table:control group（group C）and nimodipine group（group N）.Nimodipine 7.5μg/（kg·h）was intravenously infused starting from 30 min before anesthesia induction until the end of surgery in group N,while the equal volume of normal saline was given in group C.At 30 min before infusing nimodipine（T₁）,immediately after tracheal intubation(T₂),at 1 h after skin incision（T₃）and at the end of surgery（T₄）,blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Jugular bulb oxygen content,arterial-jugular bulb oxygen content difference,cerebral oxygen uptake rate and jugular-arterial lactate concentration difference were calculated.The concentrations of S100βprotein and brain-derived neurotrophic factor（BDNF）in serum of the jugular bulb were measured by enzyme-linked immunosorbent assay.The occurrence of POD was recorded within 3 days after operation.Results:Compared with group C,jugular bulb oxygen content was significantly increased,and arterial-jugular bulb oxygen content difference and cerebral oxygen uptake rate were decreased at T_3-4,the concentrations of serum S100βprotein were decreased and the concentrations of brain-derived neurotrophic factor were increased at T_2-4,and the incidence of POD was decreased（P<0.05）,no significant change was found in jugular-arterial lactate concentration difference at each time point in group N（P﹥0.05）.Conclusions:Nimodipine can reduce the development of POD,and the mechanism may be related to improving intraoperative cerebral oxygen metabolism and reducing brain injury in elderly patients.