β淀粉样蛋白1-40与老年患者颌面外科手术后并发谵妄的关系

Relationship between beta amyloid protein 1-40 and post-operative delirium after oral and maxillofacial surgery in elderly patients

目的观察老年颌面外科手术患者全身麻醉后术后谵妄(PD)的患病率,研究血浆β淀粉样蛋白1-40(Aβ1-40)与PD的关系。方法选择50例颌面外科手术患者,按照年龄分为T组(30例,年龄62～78岁)和C组(20例,年龄20～60岁),2组均采用静吸复合麻醉,以谵妄评定量表1998年修订版(DRS-R-98)来诊断和评估PD发生状况,记录术前(T0),术后24 h(T1)、48 h(T2)、72 h(T3)、96 h(T4)的DRS-R-98评分;并测定Aβ1-40质量浓度。结果 T组患者PD的患病率为20.0%。T组Aβ1-40质量浓度在T0、T1、T2、T3时段明显高于C组(P<0.01),T组和C组Aβ1-40质量浓度在T1和T2时段明显高于同组T0时段(P<0.05)。T组在T3和T4时段的DRS-R-98评分明显高于同组T1时段和C组(P<0.01)。结论 Aβ1-40在全身麻醉后持续升高可能是老年患者发生PD的重要原因之一。

Objective To determine the incidence of post-operative delirium after oral and maxillofacial surgery under general anesthesia in elderly patients,and to examine its association with plasma concentrations of beta amyloid protein 1-40（Aβ1-40）.Methods Fifty patients underwent elective oral and maxillofacial surgery were divided into two groups： Group C（n=20） aged from 20 to 60 years old,and Group T（n=30） aged from 62 to 78 years old.The two group received the same general anesthesia.Delirium rating scale-revised-98（DRS-R-98） was used as an instrument to diagnose and access the postoperative delirium of the two groups.The scores of DRS-R-98 were recorded before operation（T0） and at 24 h（T1）,48 h（T2）,72 h（T3） and 96 h（T4） after the operation.Serial measurements of serum concentrations of Aβ1-40 were also performed at the same time.Results The incidence of post-operative delirium after oral and maxillofacial surgery in Group T was 20.0%.The concentrations of plasma Aβ1-40 in group T were much higher than group C at T0,T1,T2 and T3 significantly（P0.01）.The concentrations of plasma Aβ1-40 at T1 and T2 were higher than those at T0 in the same group（P0.05）.The scores of DRS-R-98 in Group T at T3 and T4 were much higher than those at T1 and Group C significantly（P0.01）.Conclusion The constant increase of plasma Aβ1-40 may be one of the important factors related to post-operative delirium in elderly patients underwent oral and maxillofacial surgery.