青少年特发性脊柱侧凸患者围术期外周血白介素-1β及白介素-6水平变化与术后认知功能障碍发生的关系

摘要

目的 观察青少年特发性脊柱侧凸矫形术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生,并探讨其发生与外周血白介素(interleukin,IL)-1β和IL-6水平变化的关系. 方法 拟选入择期行脊柱后路矫形术患者67例,根据是否发生POCD将患者分为POCD组和非POCD组.监测入院时(T0)、术前(T1)、术毕(T2)及术后第2天(T3)4个时刻的血清IL-1β及IL-6浓度并于术前1d、术后7d评估患者POCD的发生情况. 结果 共有66例患者完成所有测试,其中19例患者发生POCD,发生率为28.8％.统计结果表明:两组患者入院和术前血清IL-1β和IL-6浓度差异无统计学意义,而术毕及术后较基础水平均升高,但组间差异无统计学意义(P＞0.05);此外,组间比较术中及术后各记录指标发现,与非POCD组[(218±270) ml]比较,POCD组[(380±341) ml]患者自体血的输入量较多(P＜0.05). 结论 青少年特发性脊柱侧凸患者术后7d认知功能障碍发生率为28.8％,需要引起足够的重视,本试验发现外周血IL-1β及IL-6水平与POCD发生无关,但结果提示术中自体血回输量可能与POCD发生有关,需要进一步研究.%Objective To observe the occurrence of postoperative cognitive dysfunction (POCD) in adolescent scoliosis patients after orthopedic surgery and study its association with levels of serum interleukin (IL)-1β/IL-6 during perioperative period.Methods Sixty-seven adolescent scoliosis patients,who were scheduled for orthopedic surgery with general anesthesia were proposed to be enrolled.The levels of serum IL-1β and IL-6 were measured on the day for admission(T0),before surgery(T1),at the end of the surgery (T2) and the second day after surgery (T3) respectively and neurocognitive testing was performed at 1 d before surgery and 1 week after operation.Age,sex,years of education,past medical history,and visual analogue scale score after surgery,duration of surgery and other intraoperative indexes and also postoperative complications were recorded.According to the diagnostic criteria of POCD,patients were divided into two groups:POCD and NPOCD.All the data were put for statistical analysis.Results Sixty-six patients completed all these tests.Nineteen patients developed POCD,so the occurrence was 28.8％ at 7 d postoperatively.Statistical analysis showed that there were no differences in the levels of serum IL-1β and IL-6 at T0 and T1 in all the patients,while the concentrations increased at T2 and T3,but there were no differences between the two groups.In addition,comparisons between the two groups showed that the infusion of the volume of autologous blood in POCD group [(380±341) ml]was more than that in NPOCD group [(218±270) ml](P＜0.05).Conclusions The incidence of POCD is 28.8％ on the seventh day after scoliosis orthopedic surgery.It reminds us that we should cause enough attention on such surgeries.We did not found the relationship between the levels of serum IL-1beta/IL-6 and the occurrence of POCD,but the result sμggested that the volume of infused autologous blood might be associated with the occurrence of POCD,and further research was needed.