MRI测定海马体积预测老年患者发生术后认知功能障碍的准确性  

Accuracy of hippocampal formation measurement by MRI in predicting postoperative cognitive dysfunction in elderly patients

作　　者：陈明华[1] 欧阳文[1] 

机构地区：[1]中南大学湘雅三医院麻醉科,长沙市410013

出　　处：《中华麻醉学杂志》2010年第3期306-309,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价术前MRI测定海马体积预测老年患者发生术后认知功能障碍（POCD）的准确性.方法 拟行胃肠道手术的患者41例,年龄≥65岁,分别于术前和术后4d采用韦氏成人记忆、智力量表中的敏感项目、联线和钉板测试进行神经心理学测试.术后4d借鉴国际术后认知功能障碍研究组织推荐的Z分法评价认知功能,根据是否发生POCD分为POCD组和非POCD组.术前采用MRI测定海马体积,海马体积与Z分间进行直线相关分析,分析海马体积对POED的预测价值.结果 36例老年患者完成本试验,其中13例患者发生了POCD,发生率为36%.POCD组海马体积（4.75 4±0.23）小于非POCD组（5.06±0.31）（P〈0.01）.海马体积与Z分间呈负相关（r=-0.324,P〈0.05）.以海马体积预测发生POCD的准确率为77.8%,灵敏度为92.3%,特异度为70.0%,约登指数为0.623.结论 术前采用MRI测定的海马体积可准确地预测老年患者是否发生POCD.Objective To assess the accuracy of MRI measurement of hippocampal formation in predicting postoperative cognitive dysfunction （POCD） in elderly patients.Methods Forty-one ASA Ⅱor Ⅲ patients aged≥65 yr undergoing gastrointestinal tract surgery were enrolled in this study.MRI was performed to measure the volume of hippocampal formation before surgery and the results were standardized according to the individual intracranial volume.All patients underwent a battery of neuropsychological tests including sensitive tests on the Wechsler adult memory scale and Wechsler adult intelligence scale,trail making test and the grooved pegboard test.We used the Z score to identify POCD as recommended by Moiler.All patients were then divided into POCD group and non-POCD group according to the results of the neuropsychological tests.The results of the tests were correlated with the volume of hippocampal formation measured by MRI.The value of MPI measurement of hippocampal volume in predicting POCD was analyzed.Results Thirty-six patients completed the whole battery of neuropsychological tests after surgery.Thirteen of the 36 patients were found to have COPD （36%） on the 4th postoperative day.The hippocampal volume was significandy smaller in POCD group （4.75±0.23） than in non-POCD group（5.06±0.31）.Hippocampal volume was found to be effective in predicting POCD.The overall accuracy of prediction was 77.8%（28/36 patients） with 92.3% sensitivity （12/13 patients）,70.0% specificity （16/23 patients） and 0.623 Youden index.Conclusion The MRI measurement of hippocampal volume is valuable as a predictor of POCD in the elderly.

关 键 词：海马 认知障碍 手术后并发症 老年人 

分 类 号：R614[医药卫生—麻醉学]