脊髓外科手术术后精神障碍患者发病影响因素及抑制性神经递质水平、神经营养因子表达变化情况分析

Analysis of the Influencing Factors,Inhibitory Neurotransmitter Levels and Neurotrophic Factor Expression Changes in Patients with Mental Disorders after Spinal Cord Surgery

目的:探讨与分析脊髓外科手术术后精神障碍患者发病影响因素及抑制性神经递质水平、神经营养因子表达变化情况。方法:选择2016年9月到2021年5月本院完成脊髓外科手术的患者83例作为研究对象,检测血清抑制性神经递质水平、神经营养因子(NTFs)表达水平。所有患者都给予抑郁自评量表(SDS)调查、执行功能行为评定量表成人版自评问卷(BRIEF-A)评分并进行相关性分析。结果:83例患者术后平均SDS评分为45.10±2.87分,判定为精神障碍23例(精神障碍组),占比27.7%。精神障碍组的性别、年龄、手术时间、术中出血量与非精神障碍组对比无差异(P>0.05),精神障碍组的饮酒、术后清醒时间与非精神障碍组对比有差异(P<0.05)。精神障碍组的BRI自我控制、情感控制、转移、抑制等评分与MI任务启动、任务监督、工作记忆、计划、组织评分都高于非精神障碍组(P<0.05)。精神障碍组的血清NTFs含量低于非精神障碍组,血清HA与5-HT含量高于非精神障碍组(P<0.05)。在83例患者中,Pearson分析显示SDS评分与饮酒、术后清醒时间、血清NTFs、NA、5-HT含量都存在相关性(P<0.05);二分类logistic逐步回归显示术后清醒时间、血清NTFs、NA、5-HT含量都为导致脊髓外科手术术后精神障碍患者发病的重要因素(P<0.05)。结论:脊髓外科手术术后精神障碍的发生较常见,可导致患者认知与执行功能降低,多伴随有抑制性神经递质水平表达上升与神经营养因子表达下降,血清NTFs、NE、5-HT含量都为导致精神障碍发病的重要因素。

Objective:To explore and analysis the influencing factors,inhibitory neurotransmitter levels and neurotrophic factor expression changes in patients with mental disorders after spinal cord surgery.Methods:From September 2016 to May 2021,83 cases of patients who completed spinal cord surgery in our hospital were selected as the research subjects,and the serum levels of inhibitory neurotransmitters and neurotrophic factor(NTFs)were detected.All patients were given self-rating depression scale(SDS)survey,Behavior Rating Inventory of Executive Function-Adult Version(BRIEF-A)survey and correlation analysis.Results:The average postoperative SDS score of 83 patients were 45.10±2.87 points,and there were 23 patients(mental disorder group)were judged to be mental disorders,accounted for 27.7%.There were no difference in gender,age,operation time,intraoperative blood loss between the mental disorder group and the non-mental disorder group(P>0.05).The terms of alcohol consumption,and postoperative sobriety time in the mental disorder group were compared with the non-mental disorder group difference were significant(P<0.05).The scores of BRI self-control,affective control,transfer,inhibition,and MI task initiation,task supervision,working memory,planning,and organization scores in the mental disorder group were different with non-mental disorder group(P<0.05).The levels of serum neurotrophic factors in the mental disorder group were different with the non-mental disorder group,and the serum HA and 5-HT levels were different with the non-mental disorder group(P<0.05).In the 83 patients,Pearson analysis showed that SDS scores were correlated with alcohol consumption,postoperative sobriety time,serum neurotrophic factor,NE,5-HT levels(P<0.05).Postoperative awake time,serum neurotrophic factor,NE,5-HT levels were all important factors leaded to the onset of mental disorders in patients with postoperative spinal cord surgery(P<0.05).Conclusion:The occurrence of mental disorders after spinal cord surgery is relatively common,which can lead to the decline of cognitive and executive function in patients,which is often accompanied by the increasing in the expression of inhibitory neurotransmitters and the decreasing in the expression of neurotrophic factors.Serum neurotrophic factors,NE,5-HT content are the important factor leading to the onset of mental disorders.