BACKGROUND: The goal of this study was to investigate the efficacy of neostigmine on postoperative cognitive dysfunction (POCD) and determine its effect on systematic markers of oxidative stress in older patients. METHODS: This double-blind placebo-controlled trial enrolled 118 elderly patients (≥65 years) undergoing noncardiac surgeries who were allocated to a neostigmine treatment group (0.04 mg/kg) or a placebo control group (normal saline) postoperatively. POCD was diagnosed if the Z-scores for the mini-mental state examination and the Montreal Cognitive Assessment were both ≤−1.96. Postoperative serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), and brain-derived neurotrophic factor (BDNF) were also compared. Multivariable regression analysis with dose adjustment of atropine was used to demonstrate the influence of neostigmine on the incidence of POCD. RESULTS: Patients receiving neostigmine had a significantly reduced incidence of POCD compared to patients who were treated with placebo on the first day after surgery (−22%, 95% confidence interval [CI], −37 to −7), but not on the third (8%, 95% CI, −4 to 20) or seventh day after surgery (3%, 95% CI, −7 to 13). Postoperative plasma MDA levels were significantly lower (P = .016), but SOD and BDNF levels were increased (P = .036 and .013, respectively) in the neostigmine group compared to the control group on the first day after surgery. CONCLUSIONS: Neostigmine reduced POCD on the first day after noncardiac surgery in older patients. Neostigmine treatment inhibited oxidative stress and increased serum BDNF levels. There was no significant influence of neostigmine on POCD on the third or seventh day after surgery. The clinical influence of neostigmine on POCD should be further investigated.

中文翻译：

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新斯的明对接受非心脏手术的老年患者术后早期认知功能障碍的影响：双盲、安慰剂对照、随机对照试验

背景：本研究的目的是调查新斯的明对术后认知功能障碍（POCD）的疗效，并确定其对老年患者氧化应激系统标志物的影响。方法：这项双盲安慰剂对照试验纳入了 118 名接受非心脏手术的老年患者（≥65 岁），术后被分配到新斯的明治疗组（0.04 mg/kg）或安慰剂对照组（生理盐水）。如果简易精神状态检查和蒙特利尔认知评估的 Z 分数均≤−1.96，则诊断为 POCD。还比较了术后血清丙二醛（MDA）、超氧化物歧化酶（SOD）和脑源性神经营养因子（BDNF）的水平。采用阿托品剂量调整的多变量回归分析来证明新斯的明对 POCD 发生率的影响。结果：与术后第一天接受安慰剂治疗的患者相比，接受新斯的明治疗的患者 POCD 发生率显着降低（−22%，95% 置信区间 [CI]，−37 至 −7），但在术后第一天则没有显着降低。术后第三天（8%，95% CI，-4 至 20）或术后第七天（3%，95% CI，-7 至 13）。术后第一天，与对照组相比，新斯的明组术后血浆 MDA 水平显着降低 (P = .016)，但 SOD 和 BDNF 水平升高（分别为 P = .036 和 0.013）。结论：新斯的明可降低老年患者非心脏手术后第一天的 POCD。新斯的明治疗可抑制氧化应激并增加血清 BDNF 水平。新斯的明对术后第3、7天的POCD无显着影响。新斯的明对 POCD 的临床影响值得进一步研究。