摘要
目的:探讨全身麻醉和硬膜外麻醉对老年髋关节置换术患者术后认知功能障碍(POCD)的影响,初步探讨其发生机制。方法:老年髋关节置换术100例,随机分为全身麻醉组与硬膜外麻醉组,分别于术前1 d(T1)、术后第1天(T2)和第5天(T3)采用简易智能量表(MMSE)对两组患者认知情况进行评分,采用酶联免疫吸附法(ELISA)检测血清β-淀粉样蛋白(amyloidβ-protein,Aβ)和神经元微管相关蛋白(Tau蛋白)水平变化,依据T2时有无POCD将患者分为观察组与对照组,对比两组患者血清Aβ、Tau蛋白水平变化。结果:全身麻醉组T2时点MMSE评分低于硬膜外麻醉组,POCD发生率高于硬膜外麻醉组(P<0.05),血清Aβ、Tau蛋白水平高于硬膜外麻醉组(P<0.05);观察组T2时点血清Aβ、Tau蛋白水平高与对照组。结论:全身麻醉患者POCD的发生率高于硬膜外麻醉患者,血清Ap、Tau蛋白浓度异常升高可能是POCD发生的机制之一。
Objective ： To investigate the effects of different anesthesia methods on postoperative cog- nitive dysfunction （POCD） in elderly patients after hip replacement surgery and its preliminary mecha- nism. Methods： A total of 100 elderly patients undergoing hip replacement surgery were enrolled in this study and randomized into general anesthesia group and epidural anesthesia group. Mini-mental state examination （MMSE） was used to evaluate the patients＇ cognitive ability one day before surgery （T1） , one day after surgery （T2） , and five days after surgery （T3） respectively. The patients＇venous blood samples were collected at T1, T2, and T3, and ELISA was used to determine the serum Aβ and Tau protein levels. According to the fact that whether there was a POCD at T2, the patients were divid- ed into observation group and control group and the changes of serum Aβ and Tau protein levels be- tween the two groups were compared. Results： In general anesthesia group, the MMSE score at T2 was significantly lower, and the incidence of POCD at T2 was significantly higher （ P 〈 0.05 ） than those in epidural anesthesia group. The protein levels of serum Aβ and Tau at T2 in observation group were sig- nificantly higher compared with those in control group （ P 〈 0.05 ）. Conclusions： The incidence of POCD in general anesthesia patients is higher than that in patients accepted epidural anesthesia. The rising level of serum Aβ and Tau protein may be one of the mechanisms for POCD development.
出处
《贵阳医学院学报》
CAS
2015年第1期100-103,共4页
Journal of Guiyang Medical College
关键词
麻醉
全身
麻醉
硬膜外
认知障碍
老年人
髋关节
外科手术
anesthesia, genaral
anesthesia, epidural
cognition disorders
aged
hip joint
opera-tion
