Preventive effect and mechanism of sivelestat sodium on postoperative delirium in patients undergoing emergency surgery for acute Stanford type A aortic dissection
Objective To investigate the preventive effect of sivelestat sodium on postoperative delirium(POD)in patients with acute Stanford type A aortic dissection(ATAAD)and its mechanisms.Methods Eighty patients undergo-ing emergency surgery for ATAAD were included.They were randomly divided into two groups:the sivelestat sodium group(n=40)and the control group(n=40).In the sivelestat sodium group,sivelestat sodium was intravenously infused at a rate of 10 minutes before the induction of anesthesia until the end of the surgery.In the control group,an equal volume of normal saline was intravenously infused at the same rate until the end of the surgery.The occurrence of postoperative deliri-um(POD)was assessed using the 3-minute Diagnostic Assessment for Confusion Assessment Method(3D-CAM).Periph-eral venous blood samples were collected at 24 h after surgery to extract peripheral blood mononuclear cells(PBMCs)us-ing a modified Ficoll density gradient centrifugation method.The concentration of iron ions(Fe2+),malondialdehyde(MDA)content,and superoxide dismutase(SOD)activity in PBMCs were measured using colorimetric assay.The protein levels of long-chain acyl-CoA synthetase 4(ACSL4)and glutathione peroxidase 4(GPX4)in PBMCs were assessed using Western blotting.Perioperative adverse events were recorded.Results The incidence of POD in the cilostazol sodium group was lower than that in the control group(P<0.05),but there were no significant differences in the severity score or duration of POD between the two groups.The cilostazol sodium group had lower Fe2+ concentration and MDA content,and higher SOD activity in PBMCs than the control group(all P<0.05).The expression of ACSL4 protein in PBMCs was low-er,while the expression of GPX4 protein was higher in the cilostazol sodium group than in the control group(all P<0.05).Compared with the control group,the cilostazol sodium group had shorter ICU stay and postoperative hospitalization(both P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Sivelestat sodium may prevent the occurrence of POD in patients with ATAAD,and its mechanism may be related to the in-hibition of ferroptosis,thereby reducing neurological damage.
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维普
