颈动脉斑块及血清脂蛋白相关磷脂酶A2与老年患者髋关节置换术后谵妄的关系

发布时间：2018-04-11 22:33

本文选题：颈动脉斑块 + 术后谵妄(POD)　；参考：《山东大学》2017年硕士论文

【摘要】：[背景目的]术后谵妄(postoperative delirium,POD)指术后出现的意识、感知力、注意力、思维、记忆及睡眠周期等方面的紊乱综合征,是一种病原学非特异的脑综合征,术后48-72h为发生高峰期,可逆性和波动性为其特点。老龄被认为是POD的独立危险因素。脂蛋白相关磷脂酶A2(LP-PLA2)来源于巨噬细胞、肥大细胞等炎症细胞,具有氧化应激、炎症反应作用,且与动脉粥样斑块的发生与破溃过程有关。本研究旨在探索颈动脉粥样硬化斑块(Carotid atherosclerotic plaque)稳定性及围术期血清LP-PLA2水平与老年患者的髋关节置换术后谵妄的关系。[研究方法]本课题选取2016年7月至2017年1月在山东大学齐鲁医院(青岛)于腰硬联合麻醉联合髂筋膜神经阻滞下行髋关节置换术的老年患者62例,记录患者一般情况如年龄、性别、病史(高血压、糖尿病、冠心病、心房纤颤、吸烟饮酒史、教育程度)、心电图、是否处于他汀类药物治疗中等,记录术前实验室化验结果(中性粒细胞计数、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿素氮)。术前以超声检查评估患者颈动脉是否存在斑块及并依据颈动脉狭窄程度进行分级。术后以意识错乱评估法(CAM)诊断POD,收集患者围术期(术前、术毕、术后第2天)血液标本,并以ELISA法检测血清中LP-PLA2水平。分组:根据是否存在颈动脉粥样斑块将入选研究对象分为斑块组与非斑块组,根据是否发生POD将斑块组分为谵妄亚组(POD亚组)与非谵妄亚组(非POD亚组)。[结果分析]1.斑块组与非斑块组患者一般资料比较两组患者术前一般资料(年龄、性别、术前合并症、是否处于他汀类药物治疗中、吸烟饮酒史、教育程度),术前实验室化验(中性粒细胞计数、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿素氮)分别比较,差异无统计学意义(P0.05)。2.手术相关指标、术后RASS评分及VAS评分比较斑块组与非斑块组手术持续时间、术中失血量、术中补液量、是否应用骨水泥等分别比较,差异无统计学意义,两组术后VAS评分及RASS评分差异无统计学意义(P0.05)。3.斑块组与非斑块组术后谵妄发生情况比较斑块组POD发病率为38.9%;非斑块组患者POD发病率为7.69%,两组POD发病率差异具有统计学意义(P0.05)。4.血清LP-PLA2水平斑块组与非斑块组相比,术前、术毕、术后第2天血清LP-PLA2水平差异均无统计学意义(P0.05)。斑块组中,谵妄亚组较非谵妄亚组,术前、术毕血清LP-PLA2水平差异均无统计学意义(P0.05),谵妄亚组术后第2天血清LP-PLA2水平较非谵妄亚组高(P0.05)。[实验结论]实验得出,斑块组POD发病率明显高于非斑块组,老年患者颈动脉斑块与术后谵妄的发生相关。斑块组中,谵妄亚组较非谵妄亚组,术后第2天LP-PLA2水平高,提示颈动脉斑块稳定性下降可影响POD的发生。
[Abstract]:[background] postoperative delirium delirium POD (POD) refers to the disorder syndrome of consciousness, perception, attention, thinking, memory and sleep cycle.Reversibility and volatility are its characteristics.Ageing is considered an independent risk factor for POD.Lipoprotein associated phospholipase A2 (LP-PLA2), derived from macrophages, mast cells and other inflammatory cells, has oxidative stress and inflammatory response, and is related to the occurrence of atherosclerotic plaques and the process of breaking down.The purpose of this study was to investigate the relationship between the stability of carotid atherosclerotic plaque Carotid atherosclerotic plaqueand the perioperative serum LP-PLA2 level and delirium after hip arthroplasty in elderly patients.[methods] from July 2016 to January 2017, 62 elderly patients undergoing hip arthroplasty under combined spinal-epidural anesthesia and iliac fascial nerve block in Qilu Hospital of Shandong University (Qingdao) were selected, and the general conditions of the patients were recorded, such as age.Sex, history (hypertension, diabetes, coronary heart disease, atrial fibrillation, smoking and drinking history, education level, electrocardiogram, whether in statins treatment medium, record preoperative laboratory results (neutrophil count, total cholesterol),Triglyceride, low density lipoprotein, high density lipoprotein, urea nitrogen.Preoperative ultrasonography was used to evaluate the carotid artery plaque and grade according to the degree of carotid artery stenosis.Postoperatively, the patients were diagnosed by the method of consciousness disorder assessment. The blood samples were collected during the perioperative period (preoperative, postoperative, and the second day after operation), and the serum LP-PLA2 levels were measured by ELISA method.Group: according to the presence of carotid atherosclerotic plaque, the subjects were divided into plaque group and non-plaque group, plaque subgroup was divided into delirium subgroup (POD subgroup) and non-delirium subgroup (non-delirium subgroup) according to the occurrence of POD.[result analysis] 1.The general data of patients in plaque group and non-plaque group were compared before operation (age, sex, complications before operation, whether in statins or not, smoking and drinking history).Educational level and laboratory test (neutrophil count, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, urea nitrogen) showed no significant difference (P 0.05).Comparison of operative duration, intraoperative blood loss, intraoperative fluid rehydration and bone cement use in plaque group and non-plaque group, there was no significant difference between the two groups.There was no significant difference in VAS score and RASS score between the two groups (P 0.05. 3).Comparison of postoperative delirium incidence between plaque group and non-plaque group the incidence of POD in plaque group was 38.9 and that in non-plaque group was 7.69.The difference of POD incidence between the two groups was statistically significant (P 0.05).There was no significant difference in serum LP-PLA2 levels between plaque group and non-plaque group before operation, at the end of operation and on the second day after operation. There was no significant difference in serum LP-PLA2 level between plaque group and non-plaque group (P 0.05).In the plaque group, the serum LP-PLA2 level in the delirium subgroup was significantly higher than that in the non-delirium subgroup before and after operation (P 0.05), and the level of serum LP-PLA2 in the delirium subgroup was higher than that in the non-delirium subgroup on the second day after operation (P 0.05).[conclusion] the incidence of POD in plaque group was significantly higher than that in non-plaque group. Carotid plaque was associated with postoperative delirium in elderly patients.In plaque group, delirium subgroup was higher than non-delirium subgroup, and LP-PLA2 level was higher on the second day after operation, suggesting that the decrease of carotid plaque stability might affect the occurrence of POD.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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