血浆和肽素及精氨酸加压素受体基因对妇科腹腔镜术后谵妄的预测价值

目的探讨血浆和肽素及精氨酸加压素受体基因对妇科腹腔镜术后谵妄的预测价值。方法收集择期行腹腔镜患者395例，根据是否发生术后谵妄分为对照组（320例）与谵妄组（75例）。检测两组和肽素及精氨酸加压素受体基因，采用单因素相关分析以及回归分析法进行腹腔镜全麻术后的危险因素分析。结果术前合并电解质紊乱发生率谵妄组（21.3％）较对照组（12．2％）多，术中发生低血压发生率谵妄组（17.3％）较对照组（6．9％）多，术中输血量谵妄组（439．25±74．32）ml较对照组（322．52±79．59）ml多，及术中失血过多发生率谵妄组（12．0％）较对照组（5．3％）多，术后疼痛评分谵妄组（3．13±O．32）较对照组（2．24±0．47）高，术前COR浓度比较，两组无显著差异，术前和肽素、NE、PGE浓度，术后和肽素、COR、NE、PGE浓度，两组比较均有统计学差异，两组精氨酸加压素受体基因（rs28632197）基因频率及基因型分布频率差异有统计学意义（P〈0．05），术后谵妄组c等位基因频率显著高于对照组，差异有统计学意义（P〈0．05），基因型分布频率比较，术后谵妄组CC基因型显著高于对照组，差异有统计学意义（P〈0．05）。logistic回归分析，低血压发生率（OR=1.33）、术中失血量（OR=1．01）、术后和肽素（OR=1．13）、术后去甲肾上腺素浓度（OR=1．26）、AVPR1B（rs28632197）CA／AA基因型（OR=2．98）为正相关因素。结论术后谵妄的发生与血浆和肽素及精氨加压素受体基因多态性具有一定的相关性，对术后谵妄有一定的预测价值。

Objective To investigate the predictive value of plasma, peptide and arginine vasopressin receptor gene for the postoperative delirium of gynecological laparoscopy. Methods 395 laparoscopic patients were collected in the department of gynaecology and divided into control group （320 cases） and delirium group （75 cases） according to whether postoperative delirium. The peptide hormones and arginine vasopressin receptor gene were tested in the two groups, and the risk factors of postoperative mortality in laparoscopic anesthesia were analyzed using the single factor correlation analysis and regression analysis method. Results The preoperative incidence of electrolyte disturbance in the delirium group （21.3%） was higher than that in the control group （12.2%）, the incidence ofhypotension in delirium group （ 17.3% ） was higher than the control group （ 6.9% ） , the intraoperative blood transfusion volume delirium group （ 439.25 ± 74.32 ） ml was higher than the control group （ 322.52 ± 79.59 ） ml, and the incidence of intraoperative bleeding delirium group （ 12.0% ） was higher than the control group （5.3%） , postoperative pain score delirium group （3.13± 0.32 ） was higher than the control group （ 2.24 ± 0.47 ） . Preoperative COR concentration was no significant difference in both groups. The preoperative copeptin, NE, concentration of PGE and postoperative copeptin, COR, NE, the concentration of PGE were statistically significant between the two groups. Two groups of AVPR1B （ rs28632197 ） gene frequency and genotype frequency distribution difference were statistically significant （ P〈0.05 ） , postoperative delirium group C allele frequency was significantly higher than that of control group, the difference was statistically significant （ P〈0.05 ） . Genotype distribution frequency comparison of postoperative delirium CC genotype was significantly higher than that of control group, the difference was statistically significant （ P〈0.05 ） . The incidence of hypotension （ OR=1.33 ） , intraoperative blood loss （ OR=1.01 ） , postoperative and peptide hormones （OR=1.13） , postoperative NE concentration （OR=1.26） , AVPR1B （rs28632197） CA/AA genotype were positively related factors （ OR=2.98 ） in logistic regression analysis. Conclusion The occurrence of postoperative delirium has a certain relevance to plasma copeptin and arginine vasopressin receptor gene polymorphism, has certain predictive value on postoperative delirium.