老年行髋关节置换术患者局部脑氧饱和度、血浆S100β、神经元特异性烯醇酶的变化及与术后认知功能障碍关系

Changes of regional cerebral oxygen saturation,plasma S100β,neuron specific enolase andtheir relationship with postoperative cognitive dysfunction in elderly patients undergoing hip replacement

目的探讨老年行髋关节置换术患者术中局部脑氧饱和度(regional cerebral oxygen saturation,rSO 2)变化与血浆S100β蛋白和神经元特异性烯醇酶(neuron specific enolase,NSE)的相关性,并评估其在预测术后认知功能障碍(postoperative cognitive dysfunction,POCD)中的作用。方法按照纳入标准选取2018年5月—2019年5月于中国人民解放军总医院第六医学中心行髋关节置换手术的老年患者75例,患者术中均予红外光谱仪持续监测rSO 2。分别于术前1 d、术后即刻、术后1 d和术后3 d采集患者外周血并检测血浆中S100β蛋白、NSE和C反应蛋白(C-reactive protein,CRP)的表达变化。采用简易智力状况检查法评估术后POCD的发生。结果术后共有22例患者发生POCD,术中rSO 2降低与POCD的发生显著相关(P<0.05)。患者术后各时间点S100β、NSE和CRP均高于术前水平,POCD组术后S100β和NSE表达水平显著高于非POCD组(均P<0.05)。术中rSO 2降低与术后1 d S100β和NSE的升高具有相关性,与CRP无显著相关性。对POCD危险因素进行Logistic回归分析发现,年龄、ΔrSO 2、糖尿病和术前血红蛋白是预测POCD的独立危险因素。结论老年患者髋关节置换术中rSO 2降低可能导致中枢神经系统的损伤,rSO 2降低是预测POCD的危险因素。术中加强rSO 2监测,优化血糖管理并纠正贫血可能有助于预防POCD的发生。

Objective To determine the correlation between regional cerebral oxygen saturation(rSO 2),serum S100βprotein and neuron specific enolase(NSE),and evaluate the prognostic value for postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip replacement surgery.Methods Seventy five elderly patients scheduled for hip replacement from May 2018 to May 2019 were enrolled.rSO 2 was recorded with the near-infrared spectroscopy sensor throughout the surgery.Serum S100β,NSE and C-reactive protein(CRP)were determined at the following time points:1 d pre-operation,end of the operation,1 d post-operation,and 3 d post-operation.POCD was evaluated and diagnosed with the mini-mental state examination.Results Twenty two patients were diagnosed as POCD out of the 75 patients included,and the decrease in rSO 2 was highly associated with the incidence of POCD(P<0.05).Expression of S100βprotein,NSE and CRP were increased following the surgical procedures,and the POCD patients had significantly higher levels of S100βprotein and NSE as compared to the non-POCD patients(all P<0.05).The decrease in rSO 2 was correlated with the increase of serum S100βprotein and NSE,but no significant relationship was seen between rSO 2 and CRP.Multivariate logistic regression analysis indicated that age,diabetes mellitus,ΔrSO 2 and hemoglobin were independent risk factors of POCD.Conclusion The decrease in rSO 2 might cause the injury of central nervous system,which was likely to contribute to the incidence of POCD.Close monitoring of rSO 2,optimal management of blood glucose as well as anemia rectification might provide beneficial effects on the prevention of POCD.