青少年脊柱侧凸矫形术后认知功能障碍 与血清皮质醇的关系

A study of the occurrence of cognitive dysfunction after scoliosis orthopedic surgery and its association with plasma cortisol levels in adolescent

目的观察青少年脊柱侧凸矫形手术患者的术后认知功能障碍（POCD）的发生，并探讨其 发生与血清皮质醇浓度的关系。方法选入择期行脊柱后路矫形手术患者75例，年龄11？18岁，美国麻 醉医师协会（American Society of Anesthesiologists，ASA）分级I-II级。于术前1 d、术后7 d及3月采用简易 智能评估量表（MMSE）、视觉词语学习测验等一套神经心理学测验来综合评估患者的认知功能水平，同时 测定患者人院后第2天及术后第2天的血清皮质醇水平，标为T1时刻、T2时刻，并记录患者的年龄、受教 育年限等资料以及手术时间等相关指标，进行统计分析。结果66例患者配合完成所有测试及血标本采 集，根据诊断标准，术后7 d及3月分别共有19例、5例患者发生POCD，即发生率分别为28.8%、7.6%，分 别根据两次的认知功能评估结果分组，进行统计分析。术后7 d POCD组的T2时刻皮质醇浓度[（311.01 ±mol/L]较术后 7 d 非 P0CD 组[（409.63±179.28） nmol/L]低，差异有统计学意义（P＜0.05）;术后 3 月 P0CD 组 T1 时刻的皮质醇浓度[（ 183.80±70.35）nmOl/L]较术后 3m 非 P0CD 组低[（337.35±132.77） nmol/L]，且 T2 时刻该组皮质醇浓度[（214.12± 124.77） nmol/L]亦低于非 P0CD 组[（394.94± 167.64） nmol/L]，差异均具有统计学意义（P＜0.05）;使用Marm-Whitney U检验分析两组皮质醇人院及术后浓度变化程度 发现，术后7 d分组中组间差异具有统计学意义（P=0.001）;对组间比较显示差异有统计学意义的变量进行 Logistic回归分析发现，术后1 d的分组中，两组皮质醇人院及术后浓度变化程度可能为POCD发生的危险 因素[P=0.046，OR=1.004,95% C/（ 1.000，1.007）]。结论青少年脊柱侧凸矫形术后认知功能障碍的发 生可能与围术期血清皮质醇浓度的变化有关，值得进一步研究。

Objective To evaluate the relationship between plasma cortisol levels and the occurrence of postoperative cognitive dysfunction（ POCD） in adolescent scoliosis patients following orthopedic surgery. Methods Seventy-five adolescent scoliosis patients,aged among 11-18 years, ASA 1-11,who were scheduled for orthopedic surgery with general anesthesia, were enrolled. Cognitive function was evaluated with a set of neuropsychological tests at 1 day before surgery,1 week and 3 months after operation,then the levels of cortisol on second day after ad-mission and second day after surgery were determined. Age, sex, years of education and other intraoperative indexes and postoperative complications were recorded. Results Sixty-six patients completed both sample collections and three times of neurocognitive tests. According to the diagnostic criteria,POCD occurred in 28.8% of patients at 7 days,and 7. 6% at 3 months postoperatively, and then the patients were divided into two groups： POCD and NPOCD, respectively.Statistical analysis showed that significant difference was found between the two 7 days groups in levels of cortisol at 2 days postoperatively（ POCD group（ （311.01 ±126.82）nmol/L） ,NPOCD group （ （409.63±nmol/L,P〈0.05） .There was also difference between 3 months groups both in the levels of cortisol at sec-ond day after admission and second day after surgery （P〈0.05） .The changes of cortisol levels between 7 days groups had significant difference with Mann-Whitney U test（P= 0.001） .Logistic regression analysis showed that changes of cortisol levels may be a risk factor of P0CD（P= 0.046,0R= 1.004,95% Cl （ 1.000,1.007））.Conclusion Periop-erative changes of plasma cortisol levels may be associated with the occurrence of POCD in adolescent scoliosis pa-tients ,which deserve further research.