摘要
目的探讨老年患者人工髋关节置换术后认知功能障碍(POCD)与血浆皮质醇水平的关系。方法 80例老年骨折患者在腰硬联合麻醉下接受人工髋关节置换术,于术前1 d及术后6 h、1 d、3 d、7 d检测其外周血血浆皮质醇水平,并采用简易精神状态检查量表(MMSE)评价其认知功能,按MMSE评估结果将患者分为POCD组和非POCD组进行分析。结果术后发生POCD患者共18例(22.5%)。2组术前1 d血浆皮质醇水平比较差异无统计学意义(P>0.05),POCD组术后6 h、1 d、3 d、7 d血浆皮质醇水平均明显高于术前1 d(P均<0.05);非POCD组术后6 h、术后1 d血浆皮质醇水平明显高于术前1 d(P均<0.05),但术后3、7 d血浆皮质醇水平与术前1 d比较差异无统计学意义(P>0.05);POCD组术后6 h、1 d、3 d、7 d血浆皮质醇水平均明显高于非POCD组(P均<0.05)。POCD组术后6 h、1 d、3 d、7 d MMSE评分均明显低于术前1 d(P均<0.05);非POCD组术后6 h、术后1 d MMSE评分明显低于术前1 d(P均<0.05),但术后3、7 d MMSE评分与术前1 d比较差异无统计学意义(P均>0.05);POCD组术后6 h、1 d、3 d、7 d MMSE评分均明显低于非POCD组(P均<0.05)。术后6 h、1 d、3 d、7 d血浆皮质醇水平与MMSE评分均呈负相关(r值分别为-0.674、-0.662、-0.635、-0.612,P均<0.05)。结论老年患者接受人工髋关节置换术后血浆皮质醇水平明显升高,这可能与其POCD的发生有关。
Objective To investigate the relationship between postoperative cognitive dysfunction （POCD） and plasma cortisol levels in elderly patients after hip replacement. Methods Eighty elderly patients who had suffered hip fractures received hip replacement under combined spinal and epidural anesthesia. The plasma cortisol levels in the peripheral blood were measured on the day before the surgery and at six hours and one, three, and seven days after the surgery. The cognitive functions of the patients were evaluated using the mini-mental state examination （MMSE）, and the patients were divided into a POCD group and a non-POCD group according to their MMSE results. Results POCD occurred in a total of 18 patients （22. 5% ）. No statistically significant difference between the two groups was observed in plasma cortisol levels on the day before the surgery （P 〉 0. 05 ）. In the POCD group, the postoperative plasma cortisol levels at six hours and one, three, and seven days were significantly higher than the cortisol level measured on the day before the surgery （ P 〈 0. 05 ）. In the non-POCD group, the plasma cortisol levels at six hours and one day after the surgery were markedly higher than the level on the day before the surgery （ P 〈 0. 05 ）, while the plasma eortisol levels at three and seven days after the surgery exhibited no statistically significant differences from the level on the day before the surgery （ P 〉 0.05 ）. The plasma eortisol levels of the POCD group were significantly higher than those of the non-POCD group at six hours and one, three, and seven days after the surgery （ P 〈 0. 05 ）. The MMSE scores at six hours and one, three, and seven days after the surgery were remarkably lower than the values measured on the day before the surgery （ P 〈 0. 05 ） in the POCD group. In the non-POCD group, theMMSE scores at six hours and one day after the surgery were significantly lower than the value measured on the day before the surgery （P 〈 0. 05 ）, but statistically significant differences were not found for the MMSE scores on the day before the surgery and at three and seven days after the surgery （P 〉 0. 05）. The MMSE scores of the POCD group were significantly lower than those of the non-POCD group at six hours and one, three, and seven days after the surgery （P 〈 0. 05 ）. The plasma cortisol levels at six hours and one, three, and seven days after the surgery showed a negative correlation with the MMSE scores （ the r values were - 0. 674, - 0. 662, -0. 635, and -0. 612, respectively, P 〈 0. 05 ）. Conclusions The plasma cortisol levels were significantly elevated after the surgery in elderly patients who received hip replacement, which is likely related to the occurrence of POCD.
出处
《新医学》
2015年第7期448-452,共5页
Journal of New Medicine
基金
东莞市医疗卫生类科研立项课题项目(201310515000350)
