老年患者远端缺血再灌注损伤对术后认知功能障碍发生率的影响

摘要

目的 比较老年患者膝关节置换术后的认知功能障碍(POCD)发生率,探讨血清神经元特异性烯醇化酶(NSE)、肿瘤坏死因子(TNF)-α和S100β蛋白水平与POCD发生率的相关性.方法 40例60岁以上老年患者行择期膝关节置换手术,按阻断血流时间长短分为2组,包括限时阻断组(从截骨开始到假体安装结束,G1组)和全程阻断组(手术全程阻断血流,G2组).于术前1d和术后第4天检测患者血清中NSE、TNF-α及S100β蛋白水平.参照Murkin JM推荐的神经心理学测评方法,以及Z值计算公式,计算术后患者POCD的发生率.结果 术后第4天G2组血清NSE、TNF-α和S100β蛋白水平明显高于G1组(P＜0.05).神经心理学测评结果显示,G1和G2组的POCD的发生率分别为10％和25％,G2组POCD的发生率明显高于G1组.相关性分析结果显示,G2组的POCD发生率与血清NSE、TNF-α及S100β水平具有相关性(P＜0.05).结论 远端长时间缺血损伤可增加老年患者术后POCD的发生率,其发生率与血清NSE、TNF-α及S100β水平具有相关性.%Objective To explore the effect of knee arthroplasty on the incidence of postoperative cognitive dysfunction(POCD) in elderly patients,and investigate the correlation between POCD incidence and serum neuron specific enolase (NSE),tumor necrosis factor(TNF)-α or S100β protein.Methods Forty elderly patients underwent knee arthroplasty were randomly divided into two groups by a tourniquet blocking time,including limited time group(from the beginning of osteotomy to the end of the prosthetic installation,G1 group) and entire group (the whole operation,G2 group).The vital signs of two groups were recorded during the operation.Blood samples were collected respectively at the 1 th day before surgery and 4th days after surgery,and then the protein levels of NSE,TNF-α,S100β were detected by ELISA kits.Neuropsychological tests were performed at the 1th day before surgery and 4th days after surgery.According to Murkin JM's Z value calculation formula,the incidence of POCD was calculated in two groups.Results The protein levels of NSE,TNF-α and S100β were significantly increased in G2 group compared with G1 group at the 4th days after surgery (P ＜ 0.05).The results of neuropsychological tests showed that the incidence of POCD was 10％ in G1 group,and 25％ in G2 group,and POCD incidence of G2 group was higher than that of G1group.The results of correlation analysis showed that POCD incidence of G2 group was correlated with the serum levels of NSE,TNF-α and S100β (P ＜ 0.05).Conclusion Our results demonstrate that long-term distal ischemic injury increase the incidence of POCD in elderly patients,and POCD incidence are related with serum levels of NSE,TNF-α and S100β.