老年糖尿病患者围术期血糖值与发生术后认知功能障碍的关系

The relationship between perioperativeblood glucose level and postoperative cognitive dysfunction in elderly diabetic patients

目的探讨老年糖尿病患者围术期血糖值、血清S100β蛋白(S100β)及脑氧饱和度(rSO_(2))变化与发生术后认知功能障碍(POCD)的关系。方法选取2019年1月至2020年6月该院收治的接受全身麻醉髋关节置换术老年糖尿病患者120例作为研究对象,根据不同精神状态评估表(MMSE)评分分为POCD组(48例)和对照组(72例)。测量记录两组患者术前(T0)、开始手术后30 min(T1)、术毕(T2),以及术后l h(T3)、2 h(T4)、24 h(T5)血糖值、血清S100β和rSO_(2),分析POCD组患者血糖值与血清S100β、rSO_(2)及术后7 d MMSE评分的关系。结果与对照组比较,POCD组患者T1~T5时血糖值、S-100β蛋白均升高,差异均有统计学意义(P<0.05)。POCD组患者T1、T2时rSO_(2)与对照组比较,差异均无统计学意义(P>0.05);与对照组比较,POCD组患者T3~T5时rSO_(2)明显下降,差异均有统计学意义(P<0.05)。POCD组患者T1~T5时血糖值与S100β呈正相关,与rSO_(2)呈负相关,与术后7 d MMSE呈负相关,S100β及rSO_(2)与术后7 d MMSE均呈负相关,差异均有统计学意义(P<0.05)。结论老年糖尿病患者围术期血糖值、血清S-100B蛋白及rSO_(2)变化与POCD发生相关,动态监测围术期血糖值、血清S-100B蛋白及rSO_(2)变化有助于指导临床医师的治疗。

Objective To investigate the relationship among blood glucose,serum S100 protein(S100),cerebral oxygen saturation(rSO_(2))and postoperative cognitive dysfunction(POCD)in elderly patients with diabetes.Methods A total number of elderly diabetic patients undergoing hip arthroplasty with general anesthesia were selected as study subjects.According to the mini-mental state examination(MMSE),POCD group(n=48)and control group(n=72)were divided.Blood glucose,serum S100βand rSO_(2) were measured before surgery(T0),30 min after operation(T1),and 1 h(T3)、2 h(T4)、24 h(T5)after surgery.Blood glucose,serum S100β,and rSO_(2) were compared between the two groups at each time point,and the relationship among blood glucose and serum S100β,rSO_(2),and MMSE 7 days after surgery was observed in POCD group.Results Compared with the control group,blood glucose and S100βprotein were increased in POCD group(P<0.05)at T1-T5.At T1 and T2,there was no significant difference in rSO_(2) between POCD group and control group(P>0.05).RSO_(2) decreased significantly in POCD group with T3-T5(P<0.05).At T1-T5,the blood glucose in POCD group was positively correlated with S100β(P<0.05).It was negatively correlated with rSO_(2)(P<0.05).There was a negative correlation with MMSE 7 days after surgery(P<0.05).S100βand rSO_(2) were negatively correlated with MMSE 7 days after operation(P<0.05).Conclusion Perioperative blood glucose level,serum S-100B protein and rSO_(2) changes in elderly diabetic patients are related to the occurrence of POCD,and dynamic monitoring of changesinperioperative blood glucose level,serum S-100B protein and rSO_(2) can help guide clinicians'treatment.