远端肢体缺血预处理对老年骨科患者术后认知功能障碍的影响

目的探计远端肢体缺血预处理对老年患者骨科手术后认知功能障碍（POCD）的影响。方法择期行骨科手术的老年患者60例，随机分成缺血预处理组（RIPC组）和对照组，所有患者均行腰硬联合麻醉，缺血预处理组在麻醉前用止血带充气缺血10min，然后放气休息10min，如此3个循环，而对照组只绑止血带不充气。记录两组患者简易精神状态量表（MMSE）评分，分别于术前、术后第1、3、7天抽取静脉血监测IL-1β、IL-6与TNF-α含量。结果与对照组比较，RIPC组MMSE评分高于对照组，术后认知功能障碍的发生率16．7％，低于对照组30％，差异有统计学意义（P〈0．05）；发生POCD患者其IL-1β、IL-6与TNF-α明显高于未发生认知功能障碍的患者，差异有统计学意义（P〈0．05）；RIPC组患者IL-1β、IL-6与TNF-α表达在术后第1、3、7天均低于对照组，差异有统计学意义（P〈0．05）。结论远端肢体缺血预处理能降低老年患者行骨科手术术后认知功能障碍的发生率，其机制可能与其抑制炎症因子的表达有关。

Objective To evaluate the effect of remote ischemic precondition （ RIPC ） on postoperation cognition dysfunction （ POCD ） in aged after orthopedics surgery. Methods Sixty old patients of ASA I - II underwent orthopedics surgery with combined spinal-epidural anesthesia were randomly divided into two groups： group RIPC （ n=30 ） and group C （ n=30 ） , Thirty minutes helot the anesthesia, RIPC was induced by left lower extremity ischemia using a tourniquet inflated in the RIPC group （ 3 intermittent cycles of 10 min transient right upper arm isehemia induced by inflating a blood pressure cuff to 26.6 kPa alternating with 10 min reperfusion ） . Patients in the group C underwent sham placement of the tourniquet wrapped around the left lower extremity without inflation. All patients＇ cognitive function were assessed before operation, and on 1st d, 3rd d, 7th d postoperatively by mini-mental state examination （ MMSE ） .Serum levels ofIL-6, TNF-α and IL-1β were measured by enzyme linked immunosorbent assay in all subjects. Results The incidences ＆postoperative cognitive dysfunction （ POCD ） were 16.7% in Group RIPC and 30% in Group C （ P〈0.05 ） .The scores of MMSE in Group RIPC were slightly higher than those in group C on 1st d, 3rd d, 7th d after operation （ P〉0.05 ） . The levels of IL-6, TNF-α and IL-1β were lower on 1st d, 3rd d, 7th d after operation than group C （ P〈0.05 ） . Conclusion RIPC can decrease the incidences of postoperative cognitive dysfunction for the aged undergoing orthopedics surgery, the mechanism of it that RIPC maybe can inhibit the expression oflL-6, TNF-α and IL-1β.