Background Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society. Methods A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400 μL of normal saline or 40 IU/400 μL of insulin, respectively, once daily from 5 minutes before anaesthesia induction until 3 days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1 day before and 3 days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1–3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery. Results Insulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively). Conclusions Intranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results.

中文翻译：

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鼻内胰岛素对老年人围手术期认知功能的影响：一项随机、安慰剂对照、双盲临床试验


背景 术后认知障碍是老年手术患者常见的神经并发症，加剧了家庭和社会的医疗负担。方法 将 140 例计划接受择期骨科手术或胰腺手术全身麻醉的老年患者随机分配到 S 组或 I 组，比例为 1：1。S 组和 I 组患者从麻醉诱导前 5 分钟至术后 3 天分别鼻内给予 400 μL 生理盐水或 40 IU/400 μL 胰岛素，每天一次。在手术前 1 天和手术后 3 天使用简易精神状态检查 （MMSE） 和蒙特利尔认知评估-基础 （MoCA-B） 评估围手术期认知功能，并在术后第 1-3 天使用 3 分钟的 CAM 诊断访谈 （3D-CAM） 评估术后谵妄 （POD） 发生率。术后第 1 天检测血清白细胞介素-6 （IL-6） 、肿瘤坏死因子 α （TNF-α ）、S100-β 和 C 反应蛋白 （CRP） 水平。结果 胰岛素治疗 I 组术后 MMSE 和 MoCA-B 评分显著高于 S 组 （P < 0.001，P = 0.001），I 组术后 3 天内 POD 发生率低于 S 组 （10.9% vs 26.6%，P = 0.024），与 S 组相比，I 组术后 IL-6 和 S100-β 水平受到抑制 （P = 0.034， P = 0.044）。结论 因此，鼻内胰岛素给药被认为是改善老年手术患者术后认知的潜在疗法。然而，需要一项更标准化的多中心、大样本研究来进一步验证这些结果。