术前扣带回脑血流改变对围术期老年患者认知功能障碍的预测价值  

The predictive value of preoperative cerebral blood flow changes in cingulate gyrus in perioperative cognitive dysfunction of elderly patients

作　　者：杜雪 刘苏[1] 高燕[1] 杨君君[1] 张静亚 刘健慧[1] DU Xue;LIU Su;GAO yan;YANG Jun-jun;ZHANG Jing-ya;LIU Jian-hui(Department of Anesthesiology,Tongji Hospital,Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院麻醉科,上海200065

出　　处：《复旦学报（医学版）》2022年第1期66-72,共7页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金面上项目(81974155,82171194);上海市浦江人才计划(2019PJD049)。

摘　　要：目的观察比较术后认知功能障碍(postoperative cognitive dysfunction,POCD)的老年患者术前局部脑血流(region cerebral blood flow,rCBF)变化,并研究其与患者神经精神量表结果是否存在相关性。方法选择2017—2020年在上海市同济医院择期行脊柱手术的老年(≥65岁)患者83例,所有入组患者在术前1天和术后7天由经过专业培训的神经心理学医师进行神经心理学测试,且在术前1天行非对比剂增强动脉自旋标记(arterial spinlabeling,ASL)灌注成像MRI扫描,获得ASL结果及神经心理学结果。根据POCD诊断标准(至少2个量表|Z|值≥1.96),术后将患者分为POCD组和NPOCD组。使用ASLtbx工具包和SPM8对图像进行预处理和校正,然后将图像标准化到MNI脑模板空间,获得标准化的脑灌注图像,分析比较两组患者术前ASL差异。结果最终纳入50例患者,11例(22%)发生术后POCD。POCD组右侧扣带回中段的rCBF低于NPOCD组(P<0.001)。扣带回CBF与神经精神量表JLOT、BVMT-D、DST-B的Z分相关系数r值分别为-0.631、-0.480、-0.533(P<0.05),差异均有统计学意义。结论术前MRI扣带回局部CBF改变可能有助于老年手术患者早期POCD的预测,且扣带回局部CBF与神经精神量表结果之间具有良好的相关性。Objective To observe whether region cerebral blood flow(rCBF)is altered in brain before surgery in postoperative cognitive dysfunction(POCD)patients,and whether there is a correlation with the score of neuropsychiatric scale in elderly patients.Methods A total of 83 elderly(≥65 years)patients scheduled for spinal stenosis surgery during 2017-2020 were enrolled in the study.All the participants accomplished a battery of neuropsychological tests by well-trained neuropsychologist 1 day before and 1 week after surgery.Pulsed arterial spin-labeling(ASL)MRI was scanned at least one day before surgery.POCD was defined as≥2 neuropsychological test Z-scores>1.96.The patients were devided into POCD and NPOCD group.The ASLtbx toolkit and SPM8 were applied to preprocess and correct the images,which were then standardized to the MNI brain template space to obtain standardized cerebral perfusion images.ALS in the two groups were compared.Results POCD was identified in 11 of50 patients(22%).The CBF of the right middle cingulate gyrus in POCD group was lower than that in NPOCD group(P<0.001).The correlation coefficient r of CBF with Z score of JLOT,BVMT-D and DST-B was-0.631,-0.480 and-0.533(P<0.05),respectively,which was statistically significant.Conclusion Patients’preoperative MRI cingulate gyrus local CBF may contribute to the prediction of early POCD in elderly patients,and there is a good correlation between cingulate gyrus local CBF and neuropsychiatric scales.

关 键 词：术后认知功能障碍(POCD) 局部脑血流(r CBF) 动脉自旋标记(ASL) 神经心理学量表 扣带回 

分 类 号：R614[医药卫生—麻醉学]