老年髋关节置换患者术后认知功能障碍与血清HIF-1α水平的关系  

Relationship between cognitive dysfunction and serum HIF-1α levels in elderly patients after hip replacement

作　　者：张益维[1] 葛叶盈[2] 黄自生[1] 王珏[1] ZHANG Yiw e;GE Yeying;HUANG Zisheng;et al(Department of Anesthesiology, Ningbo First Hospital, Ningbo 315010, China)

机构地区：[1]宁波市第一医院麻醉科,315010 [2]宁波市第六医院麻醉科

出　　处：《浙江医学》2018年第1期71-73,77,共4页Zhejiang Medical Journal

基　　金：宁波市科技项目(2017A610221)

摘　　要：目的探讨老年髋关节置换术患者术后认知功能障碍(POCD)与血清缺氧诱导因子-1α(HIF-1α)水平的关系。方法选取80例老年患者在椎管内麻醉下行人工髋关节置换术,分别于手术前1d、术后6h及1、3、7d检测外周血清HIF-1α水平,采用简易智力状态检查量表(MMSE)评估认知功能,根据术后第3天MMSE评估结果将患者分为POCD组(P组)和非POCD组(NP组)进行分析。结果术后发生POCD患者共19例。两组患者术前1d血清HIF-1α水平和MMSE评分比较差异均无统计学意义(均P>0.05);与术前1d相比,P组术后6h及1、3、7d血清HIF-1α水平均明显升高,MMSE评分降低(均P<0.05);NP组术后6h及1d血清HIF-1α水平升高,MMSE评分下降(P<0.05),但术后3、7d血清HIF-1α水平和MMSE评分渐恢复至术前水平(P>0.05);与NP组相比,P组术后6h及1、3、7d血清HIF-1α水平升高,MMSE评分均明显下降(均P<0.05);HIF-1α水平与MMSE评分均呈负相关(均P<0.05)。结论老年髋关节置换术后POCD的发生可能与血清HIF-1α水平升高有关。Objective To investigate the relationship between post-operative cognitive dysfunction(POCD) and serum HIF-1αlevels in elderly patients after hip replacement. Methods Eighty elderly patients with hip fractures received hip replacement under spinal anesthesia. The serum HIF-1α levels were measured at 1 d before and 6 h, 1 d, 3 d, 7 d after surgery. The cognitive functions were evaluated using the minimental state examination(MMSE) after surgery, and the patients were divided into a POCD group(P group) and non-POCD group(NP group) according to their MMSE results. Results POCD occurred in 19 patients(23.7%). No statistically significant difference in serum HIF-1α levels at 1 d before operation was observed between two groups. The HIF-1α levels in P group increased and MMSE scores decreased significantly at 6 h, 1 d, 3 d and 7 d after surgery(P<0.05), but in NP group the HIF-1α levels increased and MMSE scores decreased only at 6 h and 1 d after surgery, the levels returned to normal at 3 d and 7 d after surgery. The HIF-1α levels in P group were higher and MMSE scores were lower than those in NP group at all time points after surgery. The HIF-1α levels were negatively correlated with MMSE scores(r=-0.678,-0.632,-0.598 and-0.545, respectively, all P <0.05) at all postoperative time points. Conclusion Postoperative cognition dysfunction in elderly patients after hip replacement may be related to the increase of serum HIF-1α levels.

关 键 词：缺氧诱导因子-1Α 手术后并发症 认知障碍 髋关节置换术 

分 类 号：R687.4[医药卫生—骨科学]