Effect Of Nimodipine On Postoperative Delirium In Patients With Traumatic Brain Injury After Non-craniocerebral Surgery

Objective: To evaluate the effect of nimodipine on postoperative delirium in brain injury patients with non-craniocerebral surgery.Method: A total of 64 patients with brain trauma scheduled for non-craniocerebral surgery under general anesthesia,were selected in this study: a history of head trauma,unconscious disorder,no obvious neurological symptoms and signs,imageological examination with or without mild brain contusion or small intracranial hematoma,skull fracture,skull base fracture and symptoms of subarachnoid hemorrhage,no symptoms of brain compression,stable vital signs.The age range between the ages of 18 and 65,American Society of Anesthesiologists physical status I or II,gender not limited.Patients conforming to the criteria were randomly divided into 2 groups?n=32?using the random number table method: nimodipine test group?group N?and normal saline control group?group C?.At the same time,32 patients without traumatic brain injury who underwent surgery under general anesthesia in our hospital during the same period were selected as blank group?group B?.In group N,nimodipine was continuously injected intravenously at a rate of 7.5?g·kg^-1·h^-1from 30 min before the induction of anesthesia until the end of the operation,while patients in group B and C were given the same amount of saline intravenously under the same conditions.Blood samples were collected from the three groups before nimodipine administration?T₁?,30 min after skin resection?T2?,and after operation?T3?and separate the serum.Serum concentrations of neuron-specific enolase?NSE?,glial acidic protein?GFAP?,hypoxia inducible factor-1??HIF-1??,brain neuroglobin?Ngb?,malondialdehyde?MDA?were monitored by enzyme-linked immunosorbent assay?Elisa?.Confusion Assessment Method for the ICU?CAM-ICU?was used to evaluate whether postoperative delirium occurred within 7 days after surgery.Results: The general conditions of the three groups of patients,such as: age,BMI,ASA grade,sex proportion,degree of education,as well as the anesthesia time and the operation time were compared,and the differences were no statistically significant?P>0.05?.Compared to the base value at T_1,the concentrations of NSE?GFAP?HIF-1??Ngb?MDA in the 3 groups were significantly increased at T_2-3?P<0.05?.The concentrations of NSE?GFAP?HIF-1??Ngb?MDA in serum of group Nand group C at T_2-3and the incidence of postoperative delirium were significantly increased compared with group B,and the difference was statistically significant?P<0.05?.However,the concentrations of NSE?GFAP?HIF-1??Ngb?MDA in serum of group N at T_2-3and the incidence of postoperative delirium were significantly decreased compared with group C,and the difference was statistically significant?P<0.05?.Conclusion: Nimodipine lessen the incidence of POD after non-craniocerebral surgery in patients with traumatic brain injury,and the mechanism may be related to the improvement of cerebral ischemia,oxidative stress response and hypoxia during surgery and the alleviation of further brain injury.