老年患者远端缺血再灌注损伤对术后认知功能障碍发生率的影响

发布时间：2018-11-14 20:02

【摘要】：目的比较老年患者膝关节置换术后的认知功能障碍(POCD)发生率,探讨血清神经元特异性烯醇化酶(NSE)、肿瘤坏死因子(TNF)-α和S100β蛋白水平与POCD发生率的相关性。方法 40例60岁以上老年患者行择期膝关节置换手术,按阻断血流时间长短分为2组,包括限时阻断组(从截骨开始到假体安装结束,G1组)和全程阻断组(手术全程阻断血流,G2组)。于术前1 d和术后第4天检测患者血清中NSE、TNF-α及S100β蛋白水平。参照Murkin JM推荐的神经心理学测评方法,以及Z值计算公式,计算术后患者POCD的发生率。结果术后第4天G2组血清NSE、TNF-α和S100β蛋白水平明显高于G1组(P0.05)。神经心理学测评结果显示,G1和G2组的POCD的发生率分别为10%和25%,G2组POCD的发生率明显高于G1组。相关性分析结果显示,G2组的POCD发生率与血清NSE、TNF-α及S100β水平具有相关性(P0.05)。结论远端长时间缺血损伤可增加老年患者术后POCD的发生率,其发生率与血清NSE、TNF-α及S100β水平具有相关性。
[Abstract]:Objective to compare the incidence of cognitive dysfunction (POCD) after knee arthroplasty in elderly patients, and to investigate the correlation between serum neuron-specific enolase (NSE), tumor necrosis factor (TNF)-伪 and S100 尾 protein levels and the incidence of POCD. Methods 40 patients over 60 years old underwent selective knee arthroplasty. According to the duration of occlusion, they were divided into two groups, including the limited time group (from the beginning of osteotomy to the end of prosthesis installation, G1 group) and the whole occlusion group (complete occlusion of blood flow during operation). Group G2). The serum levels of NSE,TNF- 伪 and S100 尾 were measured 1 day before operation and 4 days after operation. According to the neuropsychological evaluation method recommended by Murkin JM and the formula of Z value, the incidence of postoperative POCD was calculated. Results the levels of serum NSE,TNF- 伪 and S100 尾 protein in G2 group were significantly higher than those in G1 group on the 4th day after operation (P0.05). The neuropsychological results showed that the incidence of POCD in G1 and G2 groups was 10% and 25%, respectively. The incidence of POCD in G1 group was significantly higher than that in G1 group. Correlation analysis showed that the incidence of POCD in G2 group was correlated with serum NSE,TNF- 伪 and S100 尾 levels (P0.05). Conclusion Long-term distal ischemic injury can increase the incidence of postoperative POCD in elderly patients, and the incidence is correlated with the levels of serum NSE,TNF- 伪 and S100 尾.
【作者单位】：安徽医科大学第一附属医院麻醉科;安徽医科大学第一附属医院骨科;
【基金】：2013年高等学校博士学科点专项科研基金联合资助课题(编号:20133420110009)
【分类号】：R614

【参考文献】