椎管内麻醉对老年髋关节置换术病人术后认知功能及NLRP3炎性小体的影响

Effect of intraspinal anesthesia on postoperative cognitive function and NLRP3 inflammasome in elderly patients undergoing hip replacement

目的探讨椎管内麻醉对老年髋关节置换术病人术后认知功能、核苷酸结合寡聚化域受体蛋白3(NLRP3)炎性小体的影响。方法选取我院2018年9月至2021年4月择期行髋关节置换术的老年病人115例,病人均行椎管内麻醉,分别在术前、术后3 d利用MMSE评估病人的认知功能,根据术后是否发生认知损害分成认知损害组和非认知损害组。采用多元Logistic回归分析术后认识损害发生的危险因素。比较2组术前及术后3 d血清NLRP3 mRNA、含半胱氨酸的天冬氨酸蛋白水解酶1(Caspase-1)mRNA表达量及IL-1β、IL-8水平,采用Pearson相关系数描述MMSE评分与NLRP3 mRNA、Caspase-1 mRNA表达量及IL-1β、IL-8水平的相关性。结果病人术后MMSE评分明显低于术前[(22.01±3.62)分比(27.45±1.01)分,P<0.001],术后认知损害发生率为30.43%(35/115)。多元Logistic回归分析显示,年龄≥68岁、糖尿病、术中低血压是术后认知损害发生的危险因素,受教育年限≥7年是术后认知损害的保护因素。认知损害组术后血清NLRP3 mRNA、Caspase-1 mRNA、IL-1β、IL-8水平均高于术前与非认知损害组(P<0.05),非认知损害组术后上述各指标水平与术前相比,差异均无统计学意义(P>0.05)。Pearson相关分析显示,病人术后MMSE评分与血清NLRP3 mRNA、Caspase-1 mRNA、IL-1β、IL-8水平均呈负相关(r=-0.601、-0.652、-0.501、-0.519,均P<0.05)。结论椎管内麻醉对老年髋关节置换术病人术后认知功能有一定影响,术后出现认知损害的病人NLRP3炎性小体指标水平明显上调,NLRP3炎性小体-IL-1β信号轴可能参与了术后认知障碍的发生。

Objective To explore the effects of intraspinal anesthesia on the postoperative cognitive function,nucleotidebinding oligomerization domain-like receptor protein 3(NLRP3)inflammasomes in the elderly patients undergoing hip replacement surgery.Methods A total of 115 elderly patients who underwent elective hip replacement surgery in our hospital from September 2018 to April 2021 were selected.All the patients underwent intraspinal anesthesia.The Mini-mental State Examination(MMSE)was used to evaluate the cognitive function of the patients before and 3 days after operation.According to the occurrence of postoperative cognitive impairment,the patients were divided into cognitive impairment group and non-cognitive impairment group.The risk factors of postoperative cognitive impairment were analyzed by multivariate Logistic regression analysis.The expressions of serum NLRP3 mRNA and cysteine-containing aspartate proteolytic enzyme 1(Caspase-1)mRNA,and the levels of interleukin(IL)-1βand IL-8 of the two groups were compared before and 3 days after operation.The correlations of MMSE score with the expressions of NLRP3 mRNA and Caspase-1 mRNA and the levels of IL-1βand IL-8 were described by Pearson correlation coefficient.Results The postoperative MMSE score of the patients was significantly lower than that before operation(22.01±3.62 vs 27.45±1.01,P<0.001).The incidence rate of postoperative cognitive impairment was 30.43%(35/115).Multivariate Logistic regression analysis showed that age≥68 years old,diabetes and hypotension during the operation were the risk factors for postoperative cognitive impairment,and education years≥7 years was the protective factor for postoperative cognitive impairment.After operation,the expressions of serum NLRP3 mRNA and Caspase-1 mRNA,and the levels of IL-1βand IL-8 in cognitive impairment group were higher than those before operation and those in non-cognitive impairment group(P<0.05).In non-cognitive impairment group,there were no statistically significant differences in the levels of the above indicators before and after operation(P>0.05).Pearson correlation analysis showed that postoperative MMSE score was negatively correlated with the expressions of serum NLRP3 mRNA and Caspase-1 mRNA and the levels of IL-1βand IL-8(r=-0.601,-0.652,-0.501,-0.519,all P<0.05).Conclusions Intraspinal anesthesia has a certain influence on postoperative cognitive function of the elderly patients undergoing hip replacement surgery.The levels of NLRP3 inflammasome indexes in the patients with cognitive impairment after surgery are significantly increased,and the NLRP3 inflammasome-IL-1βsignal axis may be involved in the occurrence of postoperative cognitive impairment.