全膝髋关节置换术患者术前轻度认知障碍与术后谵妄的关系  

Relationship between preoperative mild cognitive impairment and postoperative delirium in patients undergoing total knee/hip arthroplasty

作　　者：王彬[1] 王珊珊[2] 唐新慧 王菲[4] 王嘉涵 林旭 毕燕琳[1] Wang Bin;Wang Shanshan;Tang Xinhui;Wang Fei;Wang Jiahan;Lin Xu;Bi Yanlin(Department of Anesthesiology,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao 266071,China;Department of Cardiac Surgery,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao 266071,China;Department of Anesthesiology,Dalian Medical University,Dalian 116044,China;Qingdao Clinical Medical College,Nanjing Medical University,Qingdao 266000,China)

机构地区：[1]青岛大学附属青岛市市立医院麻醉科,青岛266071 [2]青岛大学附属青岛市市立医院心脏外科,青岛266071 [3]大连医科大学麻醉学系,大连166044 [4]南京医科大学青岛市市立医院临床医学院,青岛266000

出　　处：《中华麻醉学杂志》2022年第10期1173-1177,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(91849126)。

摘　　要：目的评价全膝髋关节置换术患者术前轻度认知障碍(MCI)与术后谵妄(POD)的关系。方法纳入2021年9月至2022年2月择期在脊椎-硬膜外联合麻醉下行全膝髋关节置换术患者625例,年龄50~90岁,ASA分级Ⅰ或Ⅱ级,术前1 d采用简易精神状态检查量表评估患者认知功能,同时采用蒙特利尔认知评估量表,根据MCI诊断标准将患者分为非MCI组(NMCI组)和MCI组。采用ELISA法检测脑脊液(CSF)β淀粉样蛋白40(Aβ40)、β淀粉样蛋白42(Aβ42)、总tau蛋白(T-tau)和磷酸化tau蛋白(P-tau)浓度。于术后1~7 d评估POD发生情况。采用二元logistic回归分析MCI与POD的关系,CSF Aβ40、Aβ42、T-tau和P-tau浓度、Aβ40/T-tau比值、Aβ42/P-tau比值和Aβ42/T-tau比值与POD及MCI的关系。结果与NMCI组相比,MCI组POD发生率升高,CSF Aβ42和Aβ40浓度、Aβ40/T-tau比值、Aβ42/P-tau比值和Aβ42/T-tau比值降低,CSF T-tau和P-tau浓度升高(P<0.05)。logistic回归分析表明,混杂因素校正前后,MCI及CSF P-tau和T-tau浓度升高为POD的危险因素,CSF Aβ42和Aβ40浓度、Aβ40/T-tau比值、Aβ42/P-tau比值和Aβ42/T-tau比值升高为POD的保护因素(P<0.05);混杂因素校正前后CSF P-tau和T-tau浓度升高为MCI的危险因素,混杂因素校正后CSF Aβ4浓度、Aβ40/T-tau比值、Aβ42/P-tau比值和Aβ42/T-tau比值升高则为MCI的保护因素(P<0.05)。结论术前MCI是全膝髋关节置换术患者发生POD的危险因素。Objective To evaluate the relationship between preoperative mild cognitive impairment(MCI)and postoperative delirium(POD)in the patients undergoing total knee/hip arthroplasty.Methods A total of 625 patients,aged 50-90 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,undergoing total knee and hip arthroplasty under combined spinal-epidural anesthesia from September 2021 to February 2022,were included.One day before surgery,the cognitive function was assessed using the Mini-Mental State Examination and the Montreal Cognitive Assessment scale.The patients were divided into non-MCI group(NMCI group)and MCI group according to the diagnostic criteria of MCI.The concentrations of amyloid beta 40(Aβ40),amyloid beta 42(Aβ42),total tau protein(T-tau)and phosphorylated tau protein(P-tau)in cerebrospinal fluid(CSF)were detected by enzyme-linked immunosorbent assay.The development of POD was assessed on 1-7 days after operation.The relationship between MCI and POD and relationship of concentrations ofβ40,Aβ42,T-tau and P-tau in CSFA,Aβ40/T-tau ratio,Aβ42/P-tau ratio and Aβ42/T-tau ratio with POD and MCI were analyzed using binary logistic regression.Results Compared with NMCI group,the incidence of POD was significantly increased,the concentrations of Aβ42 and Aβ40 in CSF,Aβ40/T-tau ratio,Aβ42/P-tau ratio and Aβ42/T-tau ratio were decreased,and T-tau and P-tau concentrations in CSF were increased in MCI group(P<0.05).The results of logistic regression analysis showed that before and after adjusting for confounding factors,increased MCI and concentrations of P-tau and T-tau in CSF were the risk factors for POD,and increased concentrations of Aβ42 and Aβ40 in CSF,Aβ40/T-tau ratio,Aβ42/P-tau ratio and Aβ42/T-tau ratio were protective factors for POD(P<0.05);elevated concentrations of P-tau and T-tau in CSF were risk factors for MCI before and after adjusting for confounding factors,and increased concentrations of Aβ4 in CSF,Aβ40/T-tau ratio,Aβ42/P-tau ratio,and Aβ42/T-tau ratio were prote

关 键 词：认知功能障碍 谵妄 手术后并发症 

分 类 号：R614[医药卫生—麻醉学]