全膝/髋关节置换术患者术前血浆白蛋白浓度与术后谵妄的关系  

Relationship between preoperative serum albumin concentrations and postoperative delirium in patients undergoing total knee/hip arthroplasty

作　　者：王彬[1] 王晓[1] 张浩然 杨云超 唐新慧 王菲[4] 王嘉涵 林旭[1] 毕燕琳[1] Wang Bin;Wang Xiao;Zhang Haoran;Yang Yunchao;Tang Xinhui;Wang Fei;Wang Jiahan;Lin Xu;Bi Yanlin(Department of Anesthesiology,Qingdao Hospital,University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital),Qingdao 266071,China;Department of Anesthesiology,Weifang Medical College,Weifang 261053,China;Graduate School of Dalian Medical University,Dalian 116044,China;College of Anesthesiology,Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]康复大学青岛医院(青岛市市立医院)麻醉科,青岛266071 [2]潍坊医学院麻醉学系,潍坊261053 [3]大连医科大学研究生院,大连166044 [4]南京医科大学麻醉学系,南京211166

出　　处：《中华麻醉学杂志》2023年第7期781-786,共6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血浆白蛋白浓度与术后谵妄(POD)的关系。方法选择本院2021年12月至2022年12月择期在脊椎-硬膜外联合麻醉下行全膝/髋关节置换术的患者500例,性别不限,年龄50~90岁,体质量50~80 kg,ASA分级Ⅰ或Ⅱ级。蛛网膜下腔穿刺成功后抽取脑脊液(CSF)标本,采用ELISA法测定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(或出院前)采用意识错乱评估量表(CAM)、谵妄程度评估量表(MDAS)评估是否发生POD及严重程度,将患者分为POD组和非POD组(NPOD组)。采用logistic回归分析筛选POD的危险因素。采用受试者工作特(ROC)曲线评价血浆白蛋白浓度和CSF生物标志物浓度预测POD的准确性,进行CSF生物标志物的中介效应分析。结果本研究最终纳入343例患者,POD发生率为23.3%。与NPOD组相比,POD组患者年龄、术前血浆白蛋白浓度和MDAS评分差异有统计学意义(P<0.05)。混杂因素校正前后,术前血浆白蛋白浓度降低及CSF P-tau、T-tau浓度升高为POD的危险因素,CSF Aβ42浓度、Aβ42/P-tau比值、Aβ42/T-tau比值升高为POD的保护因素(P<0.05)。术前血浆白蛋白浓度预测POD的ROC曲线下面积为0.668,其联合CSF生物标志物浓度预测POD的ROC曲线下面积为0.810(P<0.05)。术前血浆白蛋白对POD的直接效应为-0.0098692,总效应为0.0294437,P-tau中介效应占比33.53%。结论术前血浆白蛋白浓度降低是全膝/髋关节置换术患者POD的危险因素,对POD的预测具有临床价值。CSF P-tau在血浆白蛋白浓度与POD关系中发挥中介效应。Objective To evaluate the relationship between preoperative serum albumin concentrations and postoperative delirium(POD)in the patients undergoing total knee/hip arthroplasty.Methods Five hundred patients of both sexes,aged 50-90 yr,with body mass index of 50-80 kg,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective total knee or hip replacement under combined spinal-epidural anesthesia in our hospital from December 2021 to December 2022,were selected.Cerebrospinal fluid(CSF)samples were collected after successful subarachnoid puncture for determination of amyloid-beta 42(Aβ42),total tau protein(T-tau)and phosphorylated tau protein(P-tau)concentrations using enzyme-linked immunosorbent assay.Confusion Assessment Method and Memorial Delirium Assessment Scale were used to evaluate the occurrence and severity of POD at 1-7 days after surgery(or before discharge),and the patients were divided into POD group and non-POD group(NPOD group).Logistic regression analysis was used to identify the risk factors for POD.The accuracy of plasma albumin concentration and CSF biomarker concentration in predicting POD was evaluated by the receiver operating characteristic(ROC)curve,and the mediating effect of CSF biomarker was analyzed.Results A total of 343 patients were finally enrolled in the study,and the incidence of POD was 23.3%.There were statistically significant differences in age,preoperative plasma albumin concentration and Memorial Delirium Assessment Scale score in POD group as compared with NPOD group(P<0.05).Before and after adjusting for confounding factors,decreased plasma albumin and increased concentrations of P-tau and T-tau in CSF before operation were the risk factors for POD,and increased concentrations of Aβ42,Aβ42/P-tau and Aβ42/T-tau ratio in CSF were protective factors for POD.The area under the ROC curve of preoperative plasma albumin concentrations in predicting POD was 0.668,and the area under the ROC curve of preoperative plasma albumin concentratio

关 键 词：谵妄 手术后并发症 白蛋白类 

分 类 号：R687.4[医药卫生—骨科学]