青少年特发性脊柱侧凸患者早期术后认知功能障碍的发生及其与围术期血浆C-反应蛋白浓度的关系  

Relationship between the occurrence of early postoperative cognitive dysfunction and the levels of serum C-Reactive protein in idiopathic adolescent scoliosis patients

作　　者：郑旭[1] 彭慧萍[1] 马正良[1] 顾小萍[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,江苏南京210008

出　　处：《中国现代医学杂志》2014年第26期36-40,共5页China Journal of Modern Medicine

基　　金：国家自然科学基金(No:30872439/81171047/81070892);江苏省卫生厅课题(No:RC2011006/XK201140/H200943)

摘　　要：目的观察青少年特发性脊柱侧凸矫形术后认知功能障碍（POCD）的发生率,探讨其发生与血浆C-反应蛋白浓度变化的关系。方法拟选入择期全身麻醉下行脊柱后路矫形手术患者66例,年龄11-18岁,ASA分级Ⅰ、Ⅱ级。于入院时和术后第2天采集外周静脉血,测定血浆C-反应蛋白浓度。术前1天及术后7 d采用简易智能评估量表（MMSE）、视觉词语学习测验、stroop色词命名测验等6项神经心理学测验综合评估患者的认知功能状态,根据术后第7天是否发生POCD,将其分为POCD组和NPOCD组。记录患者的年龄、性别、受教育年限、既往病史等一般资料;术中出入量、手术时间、拔管时间等术中指标以及术后VAS评分、并发症等进行统计分析。结果 3例患者因不符合入选标准被剔除,其余63例完成测试。术后7 d共17例发生POCD,发生率为27.0%。与NPOCD组比较,POCD组患者术后第2天C-反应蛋白浓度较低,且术后第2天与入院的C-反应蛋白浓度变化差值POCD组较低（P〈0.05）;此外,组间比较术中及术后各记录指标发现,与NPOCD组相比,手术日至出院日的天数（标记为OPT）POCD组较NPOCD组显著延长（P〈0.05）。结论青少年特发性脊柱侧凸患者术后早期认知功能障碍发生可能与免疫系统异常有关,需要进一步研究。[Objective] To observe the occurrence of postoperative cognitive dysfunction in adolescent scoliosis patients after orthopedic surgery and study its association with levels of serum C-Reactive protein during perioperative period. [Methods] Sixty-six adolescent scoliosis patients, aged between 11-18 years, ASA Ⅰ-Ⅱ, who were scheduled for orthopedic surgery with generai anesthesia were proposed to be en- rolled. Venous blood samples （2 mL） were obtained on the day for admission and the second day after surgery respectively, then determined the levels of serum C-Reactive protein. Cognitive function was evaluated with a set of neuropsychological tests at 1 day before surgery and 1 week after operation. According to the diagnostic criteria of POCD, patients were divided into two groups： POCD and NPOCD. Age, sex, years of＇ education, past medical history, and VAS score after surgery, duration of surgery and other intraoperative indexes and also postoperative complications were recorded. Then conducted statistical analysis. [Results] Of all the pro- posed enrolled patients, three patients were excluded because of not meeting with the inclusion criteria, thus sixty-three patients completed all these tests. 17 patients developed POCD, so the occurrence was 27.0% at 7days postoperatively. Statistical analysis showed that compared with the NPOCD group, concentration of CRP in the POCD group was lower, in addition, the change of CRP was even lower. Furthermore, comparisons of variables during and after surgery between the two groups showed that the OPT in POCD group was much longer than that in NPOCD group （P〈0.05）. [ Conclusion] The occurrence of postoperative cognitive dysfunc- tion in idiopathic adolescent scoliosis patients might be related with abnormal condition of the immune system, which needed further research.

关 键 词：青少年 脊柱侧凸矫形术 术后认知功能障碍 C-反应蛋白 

分 类 号：R682.3[医药卫生—骨科学]