老年保胆取石术患者术后认知障碍及相关铁代谢的关系

Association between postoperative cognitive impairment and iron metabolism in gerontal patients after cholelithotomy

目的:评价老年患者认知障碍及相关铁代谢的关系.方法:选择全身麻醉下行保胆取石术老年患者120例,性别不限,年龄60-75岁,体质量45-75 kg,美国麻醉师协会(American Society of Anesthesiologists,ASA)分级Ⅱ或Ⅲ级,受教育年限≥6年.术前1 d和术后1、3、7 d进行简易智力状态检查(mini-mental state examination,MMSE)评分,麻醉诱导前30min和术后1、3、7 d采取外周静脉血,检测血清铁蛋白(serum ferritin,SF)、血清转铁蛋白(serum transferrin,TF)、转铁蛋白饱和度(transferrin saturation,TS).结果:MMSE评分结果统计可得出,术后出现认知障碍患者有31例,术后认知障碍发生率为25.8%,与术前1 d相比较,认知障碍组术后1、3 d MMSE评分、SF含量和TS测定降低,TF含量升高(P<0.05);术后7 dMMS E评分、SF、T F含量和T S测定差异无统计学意义(P>0.05);非认知障碍组术后1、3和7 d MMSE评分、SF、TF含量和T S测定差异无统计学意义(P>0.05).与非认知障碍组相比较,认知障碍组术后1、3d MMSE评分、SF含量和TS测定降低、TF含量升高(P<0.05);术后7 d MMSE评分、S F、T F含量和T S测定差异无统计学意义(P>0.05).血清转铁蛋白、转铁蛋白饱和度与术后认知障碍患者MMSE评分呈正相关(P=0.321,P=0.0287).结论:全麻老年患者术后认知障碍与铁代谢异常相关.

AIM：To evaluate the association between cognitive impairment and iron metabolism in gerontal patients after cholelithotomy.METHODS：One hundred and twenty patients（aged 60-75 years） who were treated by cholelithotomy and received intravenous inhalational anesthesia were included.All patients received mini-mental state examination（MMSE） on preoperative day 1 and postoperative days 1,3,and 7.Peripheral venous blood samples（3 mL） were collected to determine serum ferritin（SF）,transferrin（TF）,and transferrin saturation（TS） on preoperative day 1 and postoperative days 1,3,and 7.RESULTS：According to the MMSE results,there were 31 patients with postoperative cognitive dysfunction,and the incidence of postoperative cognitive dysfunction was 25.8%.Compared with the values on preoperative day 1,the MMSE score,the content of SF,and TS were significantly decreased,and the content of TF was significantly increased in the cognitive impairment group on postoperative days 1 and 3（P〈0.05）,although there were no significant differences on postoperative day 7（P〈0.05）.There were no significant differences in MMSE score,the contents of SF and TS,or TF in the non-cognitive impairment group on postoperative days 1,3,and 7（P〈0.05）.Compared with the non-cognitive impairment group,the MMSE score,the contents of SF and TS were significantly decreased,and the content of TF was significantly increased in the cognitive impairment group on postoperative days 1 and 3（P〈0.05）,although there were no significant differences on postoperative 7 d（P〈0.05）.There was a positive relation between TF,TS and MMSE score in patients with cognitive impairment（P = 0.321,P = 0.0287）.CONCLUSION：Postoperative cognitive impairment in gerontal patients is associated with iron metabolism.