不同剂量地塞米松对老年全髋/膝关节置换术术后认知功能障碍的影响  

Effects of different doses of dexamethasone on postoperative cognitive dysfunction in elderly patients undergoing total hip/knee replacement

作　　者：冯安琪 刘楠[2] 朴美花[2] 苑野[2] 裴爱月[3] 冯春生[2] FENG Anqi;LIU Nan;PIAO Meihua;YUAN Ye;PEI Aiyue;FENG Chunsheng(Department of Anesthesiology,Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shaanxi 710004,China;Department of Anesthesiology,First Hospital of Jilin University,Changchun,Jilin 130021,China;Endoscopy Center,First Hospital of Jilin University,Changchun,Jilin 130021,China)

机构地区：[1]西安交通大学附属第二医院麻醉科,西安710004 [2]吉林大学第一医院麻醉科,长春130021 [3]吉林大学第一医院内镜中心,长春130021

出　　处：《重庆医学》2021年第7期1170-1173,共4页Chongqing medicine

摘　　要：目的探讨不同剂量地塞米松对老年全髋/膝关节置换术术后认知功能障碍(POCD)的影响。方法将2019年1月至2010年6月在吉林大学第一医院行单侧全髋/膝关节置换术的300例老年患者分为高剂量组(101例)、低剂量组(100例)及对照组(99例)。在诱导前30 min,高剂量组与低剂量组分别静脉注射0.15 mg/kg与0.05 mg/kg的地塞米松,对照组给予同容量的生理盐水。比较各组POCD发生率,术前及术后1、5 d的简易智力状态评估量表(MMSE)评分、血清肿瘤坏死因子-α(TNF-α)、中枢神经特异蛋白(S100β)、神经元特异性烯醇化酶(NSE)水平。结果高剂量组的POCD发生率明显低于低剂量组与对照组(P<0.05);术后1 d,高剂量组的MMSE评分明显高于对照组(P<0.05);术后5 d,高剂量组的MMSE评分明显高于低剂量组与对照组(P<0.05);术后1 d,高剂量组的血清TNF-α、S100β及NSE水平明显低于对照组(P<0.05);术后5 d,高剂量组的血清TNF-α、S100β及NSE水平明显低于低剂量组与对照组(P<0.05)。术后1、5 d,低剂量组与对照组的POCD发生率、MMSE评分、血清TNF-α、S100β及NSE水平比较差异均无统计学意义(P>0.05)。结论0.15 mg/kg地塞米松能够降低老年全髋/膝关节置换术POCD的发生率,其机制可能与改善血清TNF-α、S100β及NSE水平有关。Objective To investigate the effects of different doses of dexamethasone on postoperative cognitive dysfunction(POCD)in elderly patients undergoing total hip/knee replacement.Methods A total of 300 elderly patients undergoing unilateral total hip or knee replacement in the First Hospital of Jilin University from January 2019 to June 2010 were divided into the high-dose group(101 cases),low-dose group(100 cases)and control group(99 cases).At 30 min before induction,0.15 mg/kg dexamethasone and 0.05 mg/kg dexamethasone were injected in the high-dose group and low-dose group respectively,and the control group was given the same volume of normal saline.The incidence rate of POCD,MMSE score,levels of serum tumor necrosis factor-α(TNF-α),S100βprotein and neuron-specific enolase(NSE)before surgery and on postoperative 1,5 d were compared among the three groups.Results The incidence rate of POCD in the high-dose group was significantly lower than that in the low-dose group and control group(P<0.05).At 1 d after surgery,the MMSE score in the high-dose group was significantly higher than that in the control group(P<0.05).Onpostoperative day 5,the MMSE score in the high-dose group was significantly higher than that in the low-dose group and control group(P<0.05).On postoperative day 1,the levels of serum TNF-α,S100βand NSE in the high-dose group were significantly lower than those in the control group(P<0.05).On postoperative day 5,the levels of serum TNF-α,S100βand NSE in the high-dose group were significantly lower than those in the low-dose group and control group(P<0.05).There was no statistically significant difference in the incidence rate of POCD,MMSE score and levels of serum TNF-α,S100βand NSE between the low-dose group and control group at 1,5 d after operation(P>0.05).Conclusion 0.15 mg/kg of dexamethasone can reduce the incidence rate of POCD in elderly patients undergoing total hip/knee replacement,its mechanism might be related to the improvement of levels of serum TNF-α,S100βand NSE.

关 键 词：全髋关节置换术 全膝关节置换术 地塞米松 剂量 术后认知功能障碍 老年 

分 类 号：R614[医药卫生—麻醉学]