老年术后谵妄患者大脑结构变化的形态测量学-磁共振成像分析

发布时间：2018-05-08 11:48

本文选题：术后谵妄 + 大脑　；参考：《临床麻醉学杂志》2017年06期

【摘要】：目的观察术后谵妄(postoperative delirium,POD)老年患者大脑灰质体积与密度的异常。方法选择择期全麻下行非心脏手术的胸腹部手术老年患者47例,男26例,女21例,年龄60~75岁,ASAⅡ或Ⅲ级,于术后第3天行认知功能评估,根据是否发生POD分为POD组和C组,均行大脑磁共振成像(MRI)扫描。运用基于体素的形态测量学(voxel-based morphometry method,VBM)分析比较两组灰质体积和密度的差异,并将有差异脑区的相应参数值与简易精神状态检查(MMSE)评分行相关性分析。结果 POD组全脑灰质体积明显小于C组(P0.01),而脑脊液体积明显大于C组(P0.01)。与C组比较,POD组双侧前额叶和右侧海马旁回的灰质体积明显减小(P0.01),双侧海马和右侧海马旁回的灰质密度明显降低(P0.001),右侧海马旁回的灰质体积与MMSE评分之间呈明显正相关(P0.05)。结论额叶区域、海马和海马旁回的灰质结构异常可能在POD的发生发展过程中扮演着重要的角色,右侧海马旁回的灰质体积可作为反映POD严重程度的参考指标之一。
[Abstract]:Objective to observe the abnormality of gray matter volume and density in aged patients with postoperative delirium POD. Methods Forty-seven elderly patients (26 males, 21 females, aged 60,75 years old) undergoing non-cardiac surgery under general anesthesia were enrolled in this study. The cognitive function was evaluated on the third day after operation. According to the occurrence of POD, they were divided into POD group and C group. Magnetic resonance imaging (MRI) was performed in all patients. The volume and density of gray matter in the two groups were analyzed and compared by voxel-based morphometry method based on voxel-based morphometry, and the correlation analysis was made between the corresponding parameters of the different brain area and the MMSE score of simple mental state examination. Results the volume of whole brain gray matter in POD group was significantly smaller than that in group C (P 0.01), while the volume of cerebrospinal fluid in group C was significantly larger than that in group C (P 0.01). Compared with group C, the gray matter volume of bilateral prefrontal lobe and right parahippocampal gyrus decreased significantly in group C, and the density of gray matter in bilateral and right hippocampal gyrus decreased significantly (P 0.001). There was a significant positive correlation between the volume of gray matter and MMSE score in right perihippocampal gyrus. Conclusion the abnormal gray matter structure in frontal lobe, hippocampus and perihippocampal gyrus may play an important role in the occurrence and development of POD. The volume of gray matter in right parahippocampal gyrus can be used as a reference index to reflect the severity of POD.
【作者单位】：海口市人民医院麻醉科;海口市人民医院放射影像科;
【基金】：海南省科技厅基金资助(KJHZ2014-20)
【分类号】：R614

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