老年肺叶切除术患者围术期血清基质金属蛋白酶-9及脂联素浓度与术后谵妄的关系  

Relationship between the concentrations of matrix metalloproteinase-9 and adiponectin and postoperative delirium in perioperative serums of elderly patients undergoing lobectomy

作　　者：谢海辉[1] 杜巍[2] 周建平[2] 张曙[1] 黄润成 韩琪[1] XIE Haihui;DU Wei;ZHUO Jianping;ZHANG Shu;HUANG Runcheng;HAN Qi(Department of Anesthesiology,thePeople Hospital of Dongguan,Dongguan 523018,China)

机构地区：[1]广东省东莞市人民医院麻醉科,523018 [2]广东省东莞市人民医院胸心外科

出　　处：《临床麻醉学杂志》2019年第2期152-155,共4页Journal of Clinical Anesthesiology

基　　金：广东省东莞市社会科技发展重点项目(2017507150715001459);广东省医学科研基金项目(C2018055)

摘　　要：目的评价老年肺叶切除术患者围术期血清基质金属蛋白酶-9(matrix metalloprote-inase-9,MMP-9)及脂联素(adiponectin,ADP)浓度与术后谵妄(postoperative delirium, POD)的相关性。方法选择择期全麻下行肺叶切除术老年患者73例,男38例,女35例,年龄65～80岁,BMI<24 kg/m^2,ASAⅠ或Ⅱ级,术后24、48和72 h采用中文版意识模糊评估量表评估认知功能,根据患者是否发生POD将患者分为两组:POD组和非POD组。于麻醉诱导前5 min(T_0)、气管拔管即刻(T_1)、术后24 h(T_2)、术后48 h(T_3)和术后72 h(T_4)采集静脉血样,测定血清MMP-9及ADP浓度。结果 13例患者发生POD,发生率为17.8%。与T_0时比较,T_1—T_4时POD组血清MMP-9浓度明显升高,血清ADP浓度明显降低(P<0.05);T_1时非POD组MMP-9浓度明显升高,血清ADP浓度明显降低(P<0.05)。T_1—T_4时POD组血清MMP-9浓度明显高于,ADP浓度明显低于非POD组(P<0.05)。结论围术期血清MMP-9浓度升高与ADP浓度下降可能参与老年肺叶切除术患者POD发生的病理生理过程。Objective To evaluate the correlation between the concentrations of matrix metalloproteinase-9(MMP-9)and adiponectin(ADP)and postoperative delirium(POD)in perioperative serum of elderly patients undergoing lobectomy.Methods Seventy-three elderly patients undergoing lobectomy under general anesthesia,38 males and 35 females,aged 65-80 years,BMI<24 kg/m^2,falling into ASA physical statusⅠorⅡ,were selected in some suitable period.All patients were divided into POD group and non-POD group according to the Chinese Version of Consciousness Assessment Scale at 24 hours,48 hours,and 72 hours after operation,and their blood samples were collected 5 minutes before induction of anesthesia(T0),at the time of tracheal extubation(T1)and at postoperative 24 hours(T2),48 hours(T3),and 72 hours(T4)to determine the concentrations of MMP-9 and ADP in their serums.Results POD occurred in 19 patients,with the incidence rate of 17.8%.The concentrations of MMP-9 at T1-T4 were significantly higher than those before lobectomy in serums in POD group,while the concentrations of ADP in serums were significantly lower than those before lobectomy(P<0.05).The concentrations of MMP-9 in serums at T1 were significantly higher than those before lobectomy in non-POD group,while the concentrations of ADP in serums were significantly lower than those before lobectomy(P<0.05).In the comparison between the two groups,the concentrations of MMP-9 in POD group at T1-T4 were significantly higher than those in non-POD group,while the concentrations of ADP in POD group were significantly lower than those in non-POD group(P<0.05).Conclusion The serum level of MMP-9 is increased and ADP is decreased in perioperative,wich maybe involved in the pathophysiological process of POD in elderly patients undergoing lobectomy.

关 键 词：基质金属蛋白酶-9 脂联素 老年 肺叶切除术 术后谵妄 

分 类 号：R614[医药卫生—麻醉学]