术前接种新型冠状病毒疫苗与患者术后谵妄的关系

Relationship between preoperative SARS-CoV-2 vaccination and postoperative delirium

目的:评价术前接种新型冠状病毒疫苗与患者术后谵妄(POD)的关系。方法:选择2020年6月至2022年6月择期在腰硬联合麻醉下行膝/髋关节置换术患者938例,性别不限,年龄50~90岁,体质量50~90 kg,ASA分级Ⅰ或Ⅱ级,术前简易智力状态检查量表评分≥24分,无沟通障碍。记录术前6个月内新型冠状病毒灭活疫苗接种情况。腰麻穿刺针成功进入蛛网膜下腔后抽取2 ml脑脊液,采用ELISA法测定β淀粉样蛋白42(Aβ42)、总tau蛋白(t-tau)和磷酸化tau蛋白(p-tau)浓度,计算Aβ42/t-tau比值和Aβ42/p-tau比值。术后7 d内或出院前,每天2次采用意识错乱评估量表评估POD发生情况。根据患者是否发生POD分为POD组和非POD组。将具有重要临床意义的POD影响因素及单因素回归分析中P<0.20的因素纳入多因素logistic回归分析,研究术前接种新型冠状病毒疫苗和脑脊液生物标志物水平与POD的关系。结果:最终纳入875例患者,其中169例患者发生了POD,发生率为19.3%。logistic回归结果显示,术前6个月内接种新型冠状病毒灭活疫苗、术前脑脊液Aβ42浓度、Aβ42/t-tau比值和Aβ42/p-tau比值升高是POD的保护因素,术前脑脊液t-tau浓度和p-tau浓度升高是POD的危险因素(P<0.05)。在加入性别、年龄、术前MMSE评分、受教育年限、饮酒史、合并高血压、糖尿病和冠心病调整混杂因素后,结果仍表明术前6个月内接种新型冠状病毒灭活疫苗是患者POD的保护因素(P<0.05)。结论:术前6个月内接种新型冠状病毒灭活疫苗是患者POD的保护因素。

Objective To evaluate the relationship between preoperative SARS-CoV-2 vaccination and postoperative delirium(POD)in the patients.MethodsA total of 938 participants of either sex,aged 50-90 yr,weighing 50-90 kg,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,with preoperative Mini-Mental State Examination score≥24,without communication barriers,undergoing elective knee or hip joint replacement under combined spinal-epidural anesthesia from June 2020 to June 2022 in Qingdao Municipal Hospital,were enrolled.The vaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation was recorded.The cerebrospinal fluid 2 ml was extracted after the puncture needle was successfully inserted into the subarachnoid space for determination of the concentrations of Aβ42,total tau protein(t-tau),and phosphorylated tau protein(p-tau)by enzyme-linked immunosorbent assay(by enzyme-linked immunosorbent assay).The Aβ42/t-tau and Aβ42/p-tau ratios were calculated.POD was assessed using the Confusion Assessment Method twice a day within 7 days after surgery or before discharge.The patients were divided into POD group and non-POD group according to whether they developed POD.The risk factors of whichP values were less than 0.20 in the univariate logistic regression would enter the multivariate logistic regression analysis to investigate the relationship between SARS-CoV-2 vaccine and level of cerebral spinal fluid(CSF)biomarkers and POD.ResultsEight hundred and seventy-four patients were finally enrolled in the analysis,of which 169 patients developed POD,with an incidence of 19.3%.The results of logistic regression showed that vaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation,preoperative concentrations of Aβ42 in CSF,and increase in Aβ42/t-tau and Aβ42/p-tau ratios were protective factors for POD,and preoperative elevated concentrations of t-tau and p-tau in CSF were risk factors for POD(P<0.05).After gender,age,preoperative Mini-Mental State Examination score,years of education,history of drinking,hypertension,diabetes mellitus and coronary heart disease were added to eliminate the influence of confounding factors,the results still showed that vaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation was a protective factor for POD.ConclusionsVaccination with SARS-CoV-2 inactivated vaccine within 6 months before operation is a protective factor for POD in patients.