老年术后谵妄患者大脑结构变化的形态测量学-磁共振成像分析

摘要

目的 观察术后谵妄(postoperative delirium,POD)老年患者大脑灰质体积与密度的异常.方法 选择择期全麻下行非心脏手术的胸腹部手术老年患者47例,男26例,女21例,年龄60~75岁,ASA Ⅱ或Ⅲ级,于术后第3天行认知功能评估,根据是否发生POD分为POD组和C组,均行大脑磁共振成像(MRI)扫描.运用基于体素的形态测量学(voxel-based morphometry method,VBM)分析比较两组灰质体积和密度的差异,并将有差异脑区的相应参数值与简易精神状态检查(MMSE)评分行相关性分析.结果 POD组全脑灰质体积明显小于C组(P<0.01),而脑脊液体积明显大于C组(P<0.01).与C组比较,POD组双侧前额叶和右侧海马旁回的灰质体积明显减小(P<0.01),双侧海马和右侧海马旁回的灰质密度明显降低(P<0.001),右侧海马旁回的灰质体积与MMSE评分之间呈明显正相关(P<0.05).结论 额叶区域、海马和海马旁回的灰质结构异常可能在POD的发生发展过程中扮演着重要的角色,右侧海马旁回的灰质体积可作为反映POD严重程度的参考指标之一.%Objective To observe the abnormality of gray matter volume and density in patients undergoing postoperative delirium (POD).Methods Forty-seven cases of aged patients, 26 males and 21 females, aged 60-75 years, ASA physical status Ⅱ or Ⅲ, were selected.On the third day after operation, cognitive function estimation was performed.The patients were assigned into group POD and group C according to whether POD occurred and brain magnetic resonance imaging (MRI) scanning was implemented.The discrepancy in gray matter volume and density between the two groups were compared using voxel-based morphometry method (VBM).Correlation analysis was performed between the corresponding parameters in the regions where notable differences between the two groups existed and minimum mental state examination (MMSE) score were found.Results Global gray matter volume of group POD was notably lower than that of group C (P<0.01).Cerebrospinal fluid volume of group POD was significantly higher than that of group C (P<0.01).Gray matter volume of bilateral frontal gyrus and right parahippocampus was remarkably reduced in group POD (P<0.001).Gray matter density of bilateral hippocampus and right parahippocampus decreased significantly (P<0.001).Right parahippocampal gray matter volume was positively correlated with MMSE score in POD patients (P<0.05).Conclusion Structural abnormality in frontal regions, hippocampus and parahippocampus may play an important role in pathogenetic and developing process of POD.Gray matter volume in the right parahippocampus may be one of reference index for POD severity.