老年患者术后认知功能障碍与2型糖尿病及糖化血红蛋白水平的关系

The Relationship between Type-2 Diabetes and HbA1c Levels, and Postoperative Cognitive Dysfunction in Elderly Patients

目的研究老年患者术后认知功能障碍（POCD）与2型糖尿病及糖化血红蛋白（HbAlc）水平的相关性。方法选择2011年1月-2013年2月择期行非心胸手术的老年患者140例，美国麻醉医师协会（ASA汾级Ⅰ～Ⅲ级。其中男78例，女62例；年龄65～86岁。有糖尿病者归为A组共70例，无糖尿病患者70例为B组。术前1d及术后1周以简易认知功能评估量表及蒙特利尔认知功能量表进行认知功能测定，比较两组患者POCD的发生牢。对A组患者，按糖化血红蛋白（HbAlc）水平，分为AH组（HbAlc〉7．5％）和AL组（HbAlc〈7．5％），对比AH组与AL组及组B组之间的关系。结果A组POCD发生率明显高于B组[（P〈0．05），且AH组POCD发生率高于AL组（P〈0．05）]；空腹血糖组间比较差异无统计学意义。结论老年糖尿病患者血糖控制不佳是发生POCD的危险因素，但空腹血糖作为POCD预测因素意义不如HbAlc。

Objective To study the correlation of postoperative cognitive dysfunction （POCD） with type-2 diabetes and glycosylated hemoglobin （HbAl c） levels in elderly patients. Methods A total of 140 elderly patients who were going to undergo non-cardiothoracic surgery in our hospital between January 2011 and February 2013 were included in this study. ASA classification was between Ⅰ and Ⅲ. There were 78 males and 62 females, aged between 65 and 86 years old. Group A had 70 patients with diabetes, while group B had another 70 corresponding patients without diabetes. One day before surgery and a week after surgery, Mini-mental State Examination （MMSE） and Montreal Cognitive Functioning Scale （MoCA） were used to test patients＇ cognitive function, and the incidence of POCD was compared between the two groups. Group A patients, according to HbAlc levels, were divided into group AH （HbAlc 〉 7.5%） and group AL （HbAlc 〈 7.5%）. And we compared the relationship between group AL and group B, and the relationship between group AH and group B. Results The incidence of POCD in group A was significantly higher than that in group B （P 〈 0.05）. Group AH had a significantly higher incidence of POCD than group AL （P 〈 0.05）. No significant difference was found in fasting plasma glucose among the groups. Conclusion Elderly diabetic patients with poor glycemic control is a risk factor for POCD occurrence, but fasting glucose as a predictor of POCD is not as good as HbAlC.