术中体温保护对老年前列腺气化电切手术患者术后早期认知功能及血清脑损伤标志物的影响

Effect of intraoperative body temperature protection on early POCD and serum levels of brain injury biomarkers in elderly patients undergoing TUVP

目的探讨术中体温保护对老年患者前列腺气化电切手术(TURP)后早期认知功能障碍(POCD)及脑损伤标志物的影响。方法选择2017年2月至2017年9月河南科技大学第一附属医院行TURP老年患者60例,采用随机数字表法将其分为常温组(对照组)和体温保护组(观察组),每组各30例。对照组患者术中给予棉被覆盖非手术区域,静脉输注液和电切冲洗液为室温液,观察组患者给予电热风加温毯覆盖非手术区域,静脉输注液和电切冲洗液为38℃加温液。术前1天(D1)、术后第1天(D2)、术后第3天(D3)采用简易智能精神状态检查量表(MMSE)进行神经精神功能测定,同时检测患者脑损伤标志物(MBP、NSE和S-100β蛋白)水平,比较两组患者术后各时间点POCD发病率,及MBP、NSE和S-100β蛋白水平变化。结果在术后D2、D3时间点对照组患者POCD发病率分别为26.67%、6.67%,均较观察组POCD发病率6.67%、0高,差异有统计学意义(P<0.05);在D1时间点,两组患者血清MBP、NSE和S-100β蛋白水平差异无统计学意义(P>0.05);D2、D3时,观察组患者血清MBP、NSE和S-100β蛋白均较对照组降低,差异有统计学意义(P<0.05)。结论术中体温保护可有效降低老年患者TURP术后POCD的发病率,降低脑损伤特异性血清标志物MBP、NSE、S-100β蛋白水平,是一种有效的防治POCD的保护措施。

Objective To investigate the effects of intraoperative body temperature protection on early postoperative cognitive dysfunction（ POCD） and serum levels of brain injury biomarkers in those elderly patients undergoing transurethral vaplrization of prostate（ TUVP）. Methods From Feb 2017 to Sep 2017,sixty elderly patients underwent TUVP treatments in our hospital were collected,and then were equally divided into the room temperature group（ control group） and the body temperature protection group（ trial group） by means of random number table. Patients in the control group had their non-operative regions covered with cotton quilts,and all intravenous infusion injections and resection irrigation fluids used were at room temperature. But patients in the trial group had their non-operative regions covered with hot wind heating blankets,and temperature of all intravenous injections and irrigation fluids were kept at 38° C. All patients were scored with the mini-mental state examination（ MMSE） scale for assessment of their mental function at 1 day before operation（ D1）,1 day after operation（ D2） and 3 days after operation（ D3）. Meanwhile,their blood levels of brain injury biomarkers（ MBP,NSE and S-100 βproteins） at these time points were also detected. The incidences of POCD,together with changes of MBP,NSE and S-100 β proteins,at each time point between the two groups were further compared. Results At the time points of D2 and D3,incidences of POCD in the control group were 26. 67% and 6. 67%,respectively,which were significantly higher than those in the trial group（ 6. 67%,0; P〈0. 05）. Although there was no significant difference between the two groups in the MBP,NSE and S-100 β proteins levels at the D1 time point,but at the D2 and D3 time points,levels of MBP,NSE and S-100 β proteins in the trial group were much lower than those in the control group,with statistically significant differences（ P〈0. 05）. Conclusion Intraoperative body temperature protection could be used as an effective protective measure for POCD prevention,because it can effectively reduce the incidence of POCD and the serum levels of brain injury specific biomarkers（ MBP,NSE and S-100 β proteins） in elderly patients.