术前血浆氧化三甲胺浓度与老年患者术后谵妄的关系  

Relationship between preoperative plasma trimethylamine oxide concentrations and postoperative delirium in elderly patients

作　　者：薄惠龙 查俊 顾琴[1] 俞又佳 李艳[1] Bo Huilong;Zha Jun;Gu Qin;Yu Youjia;Li Yan(Department of Anesthesiology,Suzhou Xiangcheng People′s Hospital,Suzhou 215131,China;Department of Anesthesiology,The Second Affiliated Hospital of Wannan Medical College,Wuhu 241000,China)

机构地区：[1]苏州市相城人民医院麻醉科,苏州215131 [2]皖南医学院第二附属医院麻醉科,芜湖241000

出　　处：《中华麻醉学杂志》2023年第8期942-945,共4页Chinese Journal of Anesthesiology

基　　金：苏州市科技发展计划项目(SYSD2019062);苏州市科技发展计划项目(SYSD2020060)。

摘　　要：目的:评价术前血浆氧化三甲胺(TMAO)浓度与老年患者术后谵妄(POD)的关系。方法:选取择期髋关节置换术患者180例,年龄≥65岁,ASA分级Ⅱ或Ⅲ级,BMI 17~30 kg/m^(2)。术前1 d采集静脉血样,采用高通量液相色谱-串联质谱法检测血浆TMAO浓度,根据血浆TMAO浓度水平按三分位数分为3组:低水平组(L组,≤1.2μmol/L)、中水平组(M组,1.3~1.9μmol/L)、高水平组(H组,≥2.0μmol/L)。均采用腹股沟上髂筋膜间隙阻滞联合静脉全身麻醉。于术后1、2、3和7 d时采用中文版意识模糊评估量表诊断POD,根据患者是否发生POD,分为POD组和非POD组。采用二元logistic回归分析评价不同血浆TMAO浓度与POD的关系。采用受试者工作特征(ROC)曲线评价血浆TMAO浓度对POD发生的预测效能。结果:L组60例,M组67例,H组53例,POD发生率分别为12%、22%和32%。H组POD发生率高于L组(P<0.05)。POD组血浆TMAO浓度高于非POD组(P<0.05)。logistic回归分析显示,H组POD发生风险是L组的3.91倍(P<0.05)。术前血浆TMAO浓度预测POD的ROC曲线下面积为0.754(95%CI 0.671~0.838,P<0.05),约登指数为0.426时,血浆TMAO浓度最佳截断值为1.625μmol/L,特异度和灵敏度分别为0.795和0.631。结论:术前血浆TMAO浓度增高的老年患者POD的发生风险升高,且其对POD具有较好的预测价值。Objective To evaluate the relationship between preoperative plasma trimethylamine oxide(TMAO)concentrations and postoperative delirium(POD)in elderly patients.Methods One hundred and eighty patients,aged≥65 yr,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,with body mass index of 17-30 kg/m^(2),scheduled for elective hip replacement,were enrolled in this study.Venous blood samples were collected at 1 day before surgery,and the plasma TMAO concentrations were measured by high throughput liquid chromatography-tandem mass spectrometry.The patients were divided into 3 groups according to the concentrations of TMAO:low-concentration TMAO group(group L,≤1.2μmol/L),moderate-concentration TMAO group(group M,1.3-1.9μmol/L),and high-concentration TMAO group(group H,≥2.0μmol/L).All patients received superior inguinal fascia iliaca compartment block combined with intravenous general anesthesia.POD was identified by the Confusion Assessment Method-Chinese Reversion scale at 1,2,3 and 7 days after operation.The patients were divided into POD group and non-POD group according to whether POD occurred.Binary logistic regression analysis was used to evaluate the relationship between different plasma TMAO concentrations and POD.The receiver operating characteristic curve was used to evaluate the efficacy of plasma TMAO concentrations in predicting the occurrence of POD.Results There were 60 cases in L group,67 cases in M group and 53 cases in H group,and the incidence of POD was 12%,22%and 32%in L,M and H groups,respectively.The incidence of POD was significantly higher in group H than in group L(P<0.05).The plasma TMAO concentration was significantly higher in POD group than in non-POD group(P<0.05).Logistic regression analysis showed that the risk of POD was 3.91 times higher in group H than in group L(P<0.05).The area under the receiver operating characteristic curve of preoperative plasma TMAO concentrations in predicting POD was 0.754(95%confidence interval 0.671-0.838,P<0.05).When the

关 键 词：老年人 谵妄 手术后并发症 氧化三甲胺 

分 类 号：R614[医药卫生—麻醉学]