右美托咪定对老年脊柱患者术后认知功能及外泌体miR-29c表达水平的影响

Effects of dexmedetomidine on postoperative cognitive function and exosomal miR-29c expression in elderly patients undergoing spinal surgery

目的探讨右美托咪定(dexmedetomidine,DEX)对老年脊柱患者术后认知功能及外泌体miR-29C表达水平的影响。方法选取120例于本院行择期骨科脊柱手术的老年患者,按照随机数字表法分为DEX和对照组,各60例。DEX组患者麻醉前10 min给予DEX 0.8μg/(kg·h),术中DEX以0.5μg/(kg·h)的速率泵注,于手术结束前30 min停药;对照组泵注等量的生理盐水。对比两组术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率和术前1 d、术后1 d、术后3 d血清外泌体miR-29c、S100-β蛋白及神经元特异性烯醇化酶(NSE)的表达水平。于术前1 d和术后1 d对入选患者行蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分,依据术后1 d的MoCA评分将所选患者分为POCD组和非POCD组,比较两组患者血清外泌体miR-29c、S100-β蛋白及NSE的表达水平。结果DEX组和对照组患者术后1 d的MoCA评分与术前1 d相比均明显下降(P<0.05);与对照组相比较,DEX组患者术后1 d的MoCA评分更高(P<0.05)。DEX组患者POCD发生率低于对照组(P<0.05),且术后1 d和术后3 d时血清S100-β蛋白、NSE和miR-29c的相对表达量也低于对照组(P<0.05)。POCD组患者术后1 d和术后3 d时血清S100-β蛋白、NSE和miR-29c的表达水平均显著高于非POCD组(P<0.05)。受试者工作特征(ROC)曲线分析显示,术后1 d NSE、S100-β蛋白、外泌体miR-29c的表达水平预测老年患者术后发生认知功能障碍风险的AUC分别为0.852,0.856,0.893。结论DEX可以降低老年患者全麻下脊柱手术POCD的发生风险,同时降低其血清外泌体miR-29c的表达水平。

Objective To investigate the effects of dexmedetomidine(DEX)on the postoperative cognitive function and the expression level of exosomal miR-29c in elderly patients undergoing spinal surgery.Methods A total of 120 elderly patients undergoing elective orthopedic spine surgery in our hospital were divided into DEX group and control group according to the random number table method,with 60 cases in each group.The patients in DEX group were given 0.8μg/(kg·h)DEX 10 min before anesthesia,and 0.5μg/(kg·h)DEX by infusion pump during the operation until 30 min before the end of the operation.The patients in control group were infused with the same volume of normal saline.The incidence of postoperative cognitive dysfunction(POCD)and the expression levels of serum exosomal miR-29c,S100-βprotein and neuron-specific enolase(NSE)one day before surgery,one day and three days after surgery were compared between DEX group and control group.The patients were divided into POCD group and non-POCD group according to the Montreal cognitive assessment(MoCA)score one day before surgery and one day after surgery.The expression levels of serum exosomal miR-29c,S100-βprotein and NSE were compared between POCD group and non-POCD group.Results The MoCA scores one day after surgery were lower than those one day before surgery in DEX group and control group(P<0.05).Compared with control group,the MoCA score in DEX group was increased one day after surgery(P<0.05).The incidence of POCD in DEX group was lower than that in control group(P<0.05),and the relative expression levels of serum S100-βprotein,NSE and miR-29c one day and three days after surgery were also lower in DEX group than in control group(P<0.05).The expression levels of serum S100-βprotein,NSE and miR-29c in POCD group were significantly higher than those in non-POCD group one day and three days after operation(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the AUCs of NSE,S100-βprotein and exosomal miR-29c expression at postoperative one day in predicting the risk of postoperative cognitive dysfunction in elderly patients were 0.852,0.856 and 0.893,respectively.Conclusion DEX can reduce the risk of POCD and the serum level of exosomal miR-29c in elderly patients undergoing spinal surgery under general anesthesia.