术后早期认知功能下降患者的血管内皮生长因子水平变化
发布时间：2018-03-29 15:34
本文选题：认知障碍 切入点：全身麻醉 出处：《安徽医科大学》2017年硕士论文
【摘要】：目的术后认知功能障碍(postoperative cognitive dysfunction POCD)作为一种术后常见并发症,在高龄患者的术后较非高龄患者中存在较高的发生率。其损害患者的认知功能包括记忆力、注意力及执行功能等,深深影响患者的术后日常生活。目前已知其发生与多种因素包括手术类型、麻醉方式年龄等相关,而对于其确切发病机制及诊断标准尚不明确,因此研究早期认知功能改变至关重要。血管内皮生长因子(vascular endothelial growth factors VEGF)又称血管通透性因子,人们最初发现VEGF作为一种最强的血管生成因子,其通过和血管内皮生长因子受体(vascular endothelial growth factors receptor VEGFR)结合可以诱导内皮细胞增殖以及迁移生长,从而形成新的血管网并因此命名为血管生长因子。近年来发现,在中枢神经系统中,其可以营养神经并起到神经保护的作用。血流动力异常改变及缺血缺氧状态均可诱发VEGF表达量的增加,并促进新的血管的再生。目前对于患者的认知功能的与其外周静脉血VEGF的改变是否相关知之甚少。我们假设术后认知功能下降与血管内皮生长因子的变化存在相关性。本课题研究在目的于探讨气管插管全麻老年患者外周血VEGF和早期认知功能下降的相关性,为临床早期预防术后认知功能障碍提供可能的监测指标。方法首先选择老年骨科手术患者,年龄≥65岁,无心脑血管疾病和精神类药物使用史。对患者术前和术后采用简易智能精神状态检查表(mini-mental state examination MMSE)进行认知评分,以此明确患者认知功能状况。然后根据患者术前、术后评分差异将实验对象分为两组:实验组或认知功能下降组20例,以及对照组22例。对于术后2h认知功能评分比术前1d下降≥2分的患者被划分为实验组,术后2h认知功能评分比术前1d无改变或增加为1分的患者被分为对照组。另外,本实验分别于麻醉诱导前15min(T0),术中1h(T1),术后2h(T2),术后1d(T3)四个时间点采取少量静脉血,然后依据酶联免疫吸附剂测定(enzyme-linked immunosorbent assay,ELISA)的原理采用双抗体夹心ELISA法检测患者外周血VEGF的表达水平。结果实验组及对照组两组老年患者一般情况无显著性差异,术中生命体征、输液量以及麻醉药物剂量无显著性差异。实验组术后2h MMSE评分与术前1天评分比较有显著差异(P0.001),而对照组MMSE量表评分在术前与术后差异不明显。对于两组患者外周血VEGF值的变化,试验组与对照组外周血VEGF值在全麻诱导前15min(T0)与术中1h(T1)两组间无明显差异,而实验组与对照组术后2h VEGF表达值有显著差异(P㩳0.01)且实验组的表达量明显高于对照组。两组在术后1d(T3)也未见明显差异。结论骨科老年患者全麻手术后2小时术后认知功能下降的发生与术后2小时外周血血管内皮生长因子表达水平升高相关。
[Abstract]:Objective as a common postoperative complication, postoperative cognitive dysfunction (PC) has a higher incidence in the elderly patients than in the younger ones. The cognitive impairment of the patients includes memory, attention and executive function. It is known that its occurrence is related to many factors, such as the type of operation, the age of anesthesia, and so on, but the exact pathogenesis and diagnostic criteria are not clear. Therefore, it is important to study early cognitive changes. Vascular endothelial growth factors VEGF, also known as vascular permeability factor, was initially found to be the strongest angiogenic factor. It can induce the proliferation and migration of endothelial cells by binding to vascular endothelial growth factors receptor VEGF, thus forming a new vascular network and hence the name of vascular growth factor. In recent years, it has been found that in the central nervous system, It can nourish the nerve and play a neuroprotective role. Abnormal changes of blood flow and ischemia and hypoxia can induce the increase of VEGF expression. At present, little is known about whether the cognitive function of patients is related to the changes of VEGF in their peripheral venous blood. We assume that the decline of cognitive function after operation is related to the changes of vascular endothelial growth factor (VEGF). The purpose of this study was to investigate the correlation between peripheral blood VEGF and early cognitive impairment in elderly patients with tracheal intubation under general anesthesia. Methods the elderly patients with orthopedic surgery were selected as the first choice, aged 鈮，
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