老年患者皮质醇变化模式与微创术后早期认知功能障碍的关系

Early postoperative cognitive dysfunction is associated with the changing pattern of plasma cortisol in aged patients

目的 观察老年患者围术期血浆皮质醇变化模式及其与术后认知功能障碍（POCD）的关系.方法 选择年龄65岁及以上全麻下择期行腹腔镜胆囊切除术患者40例,采用简明精神状态检查表评定术前1d及术后4d的认知功能,根据患者术后4d认知功能水平,将患者分成POCD组和非POCD组.分别于麻醉诱导前（T0）、手术结束时（T1）、术后6h（T2）、术后12h （T3）测定血浆皮质醇（AUCg）水平.比较POCD组和非POCD组手术前后AUCg水平变化.结果 POCD组AUCg水平高于非POCD组.术后皮质醇水平与术后4d简明精神状态检查得分呈负相关.结论 行腹腔镜胆囊切除术的老年患者围术期血浆皮质醇波动变化模式与POCD发生有密切关系.

Objiective To observe the changeing pattern of plasma cortisol concentration in aged patients in the perioperative period and explore its relationship with postoperative cognitive dysfunction （POCD）.Methods POCD was evaluated by using the Mini Mental State Examination 1 day before surgery and 4 days after surgery,respectively.Patients were divided into POCD group and non-POCD group according to the cognitive function 4 days after surgery.Plasma cortisol levels were measured in 40 aged （＞ 65y） patients before surgery,at the end of surgery,6h after surgery,12h after surgery,respectively.Plasma cortisol AUCg were compared between the POCD group and the non-POCD group.Results Plasma cortisol AUCg in the POCD group was higher than that in the non-POCD group.Furthermore,plasma cortisol AUCg was negatively correlated with the score of the mini-mental state examination at 4 days after surgery （P＜0.0001）.Conclusions POCD in aged patients is closely related to the plasma cortisol pattern in the perioperative period.