围手术期降钙素原水平与腹部大手术后患者发生谵妄的关系研究

Perioperative Procalcitonin Levels and Patients After Major Abdominal SurgeryStudy on the Relationship Between Delirium Occurrence

目的研究围手术期炎症因子水平与腹部大手术患者发生术后谵妄(Postoperative delirium,POD)的关系,从而为谵妄发生、发展的机制提供依据。方法本研究最终将148例腹部大手术患者纳入研究,根据谵妄评估方法量表(The Confusion Assessment Method,CAM)和患者临床表现,将其分为谵妄组和非谵妄组,收集两组患者血清降钙素原(Procalcitonin,PCT)、C-反应蛋白(C-reaction protein,CRP)和白细胞(White blood cell,WBC)等指标水平。结果非谵妄组和谵妄组术后第1日CRP分别为64.87(46.58,83.38)mg/L和111.56(75.05,170.54)mg/L,两组差异有统计学意义(z=3.716,P<0.01);非谵妄组和谵妄组术后第1日PCT水平分别为0.54(0.26,2.15)ng/ml和7.33(4.00,15.56)ng/ml,两组差异有统计学意义(z=7.034,P<0.01);两组患者WBC水平无明显差异。结论腹部大手术发生POD的患者,术后第1日PCT和CRP水平明显升高,全身性感染性炎性反应可能参与谵妄的发生发展。

Objective To study the relationship between perioperative inflammatory factor levels and Postoperative delirium(POD)in patients undergoing major abdominal surgery,so as to provide basis for the occurrence and development mechanism of delirium.Methods In this study,148 patients with major abdominal surgery were finally included.According to The Confusion Assessment Method(CAM)and clinical manifestations of patients,they were divided into delirium group and non-delirium group.Serum Procalcitonin(Procalcitonin,procalcitonin,procalcitonin,PCT,C-reaction protein(CRP)and White blood cell(WBC).Results The CRP levels of the non-delirium group and delirium group on day 1 after surgery were 64.87(46.58,83.38)mg/L and 111.56(75.05,170.54)mg/L,respectively,and the difference was statistically significant(z=3.716,P<0.01).PCT levels in the non-delirium group and delirium group on day 1 after surgery were 0.54(0.26,2.15)ng/ml and 7.33(4.00,15.56)ng/ml,respectively,and the difference was statistically significant(z=7.034,P<0.01).There was no significant difference in the level of WBC between the two groups.Conclusions PCT and CRP levels were significantly increased in patients with POD during major abdominal surgery on the first day after surgery,and systemic inflammatory reactions may be involved in the occurrence and development of delirium.