同型半胱氨酸水平对老年髋关节置换术后认知功能障碍的影响

Effects of homocysteine levels on cognitive impairment in elderly patients with hip arthroplasty

目的:评价血清同型半胱氨酸(Hcy)水平对老年髋关节置换术患者术后认知功能障碍(POCD)的影响。方法:选择拟在脊椎-硬膜外联合麻醉下行髋关节置换术患者100例,性别不限,年龄65~81岁,ASA分级Ⅱ或Ⅲ级。按血浆Hcy浓度分为3组:A组Hcy<10μmol·L^(-1),42例;B组10μmol·L^(-1)≤Hcy<20μmol·L^(-1),36例;C组Hcy≥20μmol·L^(-1),22例。分别于术前1 d(T_0)及术后24 h(T_1)、72 h(T_2)、7 d(T_3)用MMSE评分表对患者进行认知功能评定。结果:与T_0时间点比较,B、C组T_1~T_3时间点、A组T_和T_2时间点MMSE评分降低(P<0.05或0.01);与A组比较,B、C组T_1~T_3时间点MMSE评分降低(P<0.05或0.01);与B组比较,C组T_~T_3时间点MMSE评分降低(P<0.05或0.01);POCD发生率由高到低依次为C组>B组>A组(P<0.05或0.01)。结论:血清Hcy水平可影响老年髋关节置换术后认知功能,POCD的发生率与血清Hcy浓度正相关。

Objective： To evaluate the effect of serum homocysteine （Hcy） level on post-operative cognitive dysfunction （POCD） in elderly patients with hip arthroplasty.Methods： 100 elderly patients with hip joint replacement by the combined spinal epidural anesthesia were selected,male or female,aged from 65 to 81,ASA class Ⅱ or Ⅲ.According to plasma Hcy concentration,they were divided into three groups： group A Hcy 〈10 μmol·L^（-1） （n = 42）,group B 10≤Hcy 20 μmol·L^（-1） （n = 36） and group C Hcy≥20 μmol·L^（-1） （n = 22）.The mimi-mental state examination （MMSE） was used to assess the cognitive function at 1 d preoperation （T_0） and24 h （T_）,72 h （T_2）,7 d （T_3） after the operation.Results： Compared with T_0,the MMSE scores were decreased at T_-T_3 time point in group B,C and T_,T_2 time point in group A （P〈0.05 or 0.01）; Compared with group A,MMSE scores were decreased at T_-T_3 in group B,C （P〈0.05 or 0.01）; Compared with group B,MMSE scores were decreased at T_-T_3 in group C （P〈0.05 or 0.01）; The incidence of POCD from high to low was group C,group B,and group A in turn （P〈0.05 or 0.01）.Conclusion： Serum Hcy levels can affect cognitive function in elderly patients with hip arthroplasty.The incidence of POCD is positively correlated with serum Hcy concentration.