醒脑静介导PI3K/AKT信号通路影响老年患者术后认知功能的临床研究

Clinical Studies of Xingnaojing Mediated PI3K/AKT Signaling Pathway on Cognitive Function of Elderly Patients after Surgery

目的：观察醒脑静对下肢矫形手术的老年患者术后认知功能,探讨其基于脑脊液中PI3K/AKT信号通路的作用机制。方法：选取2015年8月至2016年1月我科收治的拟行下肢矫形手术ASAⅠ~Ⅱ级老年患者90例,随机分成对照组和观察组,每组45例。观察组在患者术毕清醒时注射醒脑静注射液20 m L,对照组注射等量生理盐水。在术前1 d及术后3 d,7 d使用术后恢复质量评估（Physician Quality Reporting System,PQRS）量表新认知评价体系评估患者的认知功能水平。利用蛋白免疫印迹法检测蛛网膜下腔穿刺置管成功后（T0）、插入喉罩后即刻（T1）及手术后6 h（T2）、24 h（T3）和48h（T4）不同时间点脑脊液中PI3K、AKT、p AKT、Bcl、Bax的浓度。结果：1）术后2组患者认知功能均出现降低,对照组变化较观察组明显,2组患者术后7 d的MMSE评分恢复正常,而PQRS评分则显示患者仍存在认知功能缺损。2）PQRS评分显示,对照组术后发生术后认知功能障碍（Postoperative Cognitive Dysfunction,POCD）14例（40%）,观察组术后发生POCD10例（28%）;MMSE评分显示,对照组术后发生POCD12例（34%）,观察组术后发生POCD8例（23%）。PQRS评分显示POCD发生率明显高于简易智能量表（Mini-mental State Examination,MMSE）评分（P〈0.05）。3）Western blotting结果显示：与T0相比,2组T1、T2、T3及T4时间点PI3K、p AKT、bcl水平明显降低,而bax水平明显升高,其中各时间点对照组各标志性蛋白水平变化的趋势较观察组明显（P〈0.05）。结论：醒脑静可促进老年人下肢矫形手术患者术后认知功能的尽快回复,其影响机制可能与介导PI3K/AKT信号通路的标志性蛋白表达水平有关。

Objective： To observe Xingnaojing＇s effect on postoperative cognitive function in elderly patients with lower limbs orthopedic operation,and to discuss its influence on PI3 K/AKT signal pathway in the cerebrospinal fluid. Methods： A total of 90 cases of elderly patients with lower limbs orthopedics ASA Ⅰ - Ⅱ grade in our hospital during August 2015 and January 2016,were included into the study. According to the random principle,they were divided into observation group and control group. Cognitive function levels of the patients were assessed by postoperative recovery Physician Quality Reporting System（PQRS） the new cognitive evaluation system on one day before the surgery,and 3 d and 7 d after the surgery. The PI3 K,AKT,p AKT,Bcl,and Bax concentration changes in cerebrospinal fluid were detected by western blotting in the following time points： the finished time of the subarachnoid puncture catheter（T0）,the time when inserting a laryngeal mask（T1）,6 h（T2）,24 h（T3）,48 h（T4） after the operation. Results： 1） According to PQRS score and MMSE score of postoperative cognitive function in the patients,the scores of the two groups reduced,the changes of control group were more obviously than the observation group,MMSE scores got back to normal in both of the two groups 7 d after operation,while the PQRS scores showed that there were 14 cases（40%） in the control group,while 10 cases（28%） in the observation group; while MMSE scores showed that there were 12 cases（34 %） in the control group,while 8 cases（22%） in the observation group,the result of PQRS scores significantly higher than MMSE scores. 3）Western blotting results showed that the concentration of PI3 K,p AKT,Bcl decreased in the two groups on time points of T1,T2,T3,and T4 compared with the T0,while the Bax levels rose. The iconic protein concentration change trend of every time point of the control group was more obviously than the observation group,the differences were statistically significant（P〈0. 05）. Conclusion： Xingnaojing can improve the postoperative cognitive function in elderly patients with lower limbs orthopedic surgery,the mechanism may be related to the mediation on iconic protein expression levels of PI3 K/AKT signal pathway.