髋关节置换术后认知功能障碍与患者围术期血浆皮质醇水平的关系

The study of relationship between postoperative cognitive dysfunction and plasma cortisol levels in aged patients undergoing total hip replacement surgery

目的探讨全髋关节置换术患者术后认知功能障碍（POCD）的发生与围术期血浆皮质醇水平的关系。方法选择90例在全麻下接受择期单侧全髋关节置换术的老年患者，年龄65-75岁，应用简易精神状态量表（MMSE）对患者的认知功能进行评定，根据是否发生POCD分为POCD组和非POCD组。检测患者术前2d、术后2、7d血浆皮质醇水平。结果髋关节置换术老年患者术后7dPOCD发生率为37．8％；与术前2d比较，POCD组患者术后2、7d血浆皮质醇水平明显增高（P〈0．01或P〈0．05）；与非POCD组比较，POCD组患者术后2、7d血浆皮质醇水平明显增高（P〈0．05）。两组患者术后2、7d血浆皮质醇水平与MMSE评分呈负相关（P〈0．01）。结论老年患者全髋关节置换术后早期的POCD发生率较高，术后血浆皮质醇水平升高可能与POCD的发生有关。

Objective To investigate the relationship between postoperative cognitive dysfunction and plasma cortisol levels in aged patients undergoing total hip replacement surgery. Methods Ninety patients aged 65-75 years old, scheduled for total hip rePlacement surgery under general anesthesia were enrolled in the present study. Cognitive state was tested by mini-mental state examination （MMSE）. The patients were divided into two groups, POCD group and non-POCD group. Perioperative plasma levels of cortisol were determined on 2 d preoperative, 2 d postoperative and 7 d postoperative. Results Incidence of POCD after 7 d in aged patients undergoing total hip replacement surgery was 37.8%. Compared with day 2 d preoperative, plasma cortisol levels in POCD patients significantly increased on 2 d and 7 d post operation （P〈0. 01 or P〈0.05）. Compared with non-POCD patients, cortisol levels on the 2 d and 7 d postoperative day significantly increased in POCD patients （P〈0.05）. Plasma cortisol levels showed a negative correlation with MMSE scores on postoperative 2 d and 7 d（P〈0. 01）. Conclusion Elderly patients have a relatively higher incidence of POCD after hip replacement surgery. POCD may be caused by high plasma cortisol levels in elderly patients following hip replacement surgery under general anesthesia.