高原股骨骨折合并高原脱适应症对全身麻醉患者血流动力学、脑神经功能及认知功能的影响

Impact of concurrent high-altitude osteoporotic femoral fracture and high-altitude de-acclimatization syndrome on hemodynamics,cerebral neurologic function,and cognitive function in patients undergoing general anesthesia

目的:探讨高原股骨骨折合并高原脱适应症(HADAS)对全身麻醉患者血流动力学、脑神经功能及认知功能的影响。方法:选取2019年3月至2021年3月在西藏自治区人民政府驻成都办事处医院骨科行全身麻醉手术的高原股骨骨折合并HADAS患者69例(HADAS组)及单纯高原股骨骨折患者63例(对照组)为研究对象。记录2组患者麻醉术中血流动力学参数心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO 2),采用放射性免疫法检测脑神经功能指标S100蛋白(S100β)、髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)水平,采用酶联免疫吸附法检测炎症相关指标白细胞介素(IL)-2、IL-4、IL-13及干扰素γ(INF-γ)水平,采用简易精神状态检查(MMSE)量表和蒙特利尔认知评定(MoCA)量表评估患者的认知功能。 结果:T1时间点(气管插管后5 min)2组患者的HR、MAP、SpO 2均较T0时间点(麻醉前)降低,T2时间点(术后)2组患者的HR、MAP、SpO 2均较T1时间点升高,T1、T2时间点HADAS组患者的HR、MAP、SpO 2均低于对照组(均 P<0.05)。术后2组患者的S100β、MBP、NSE、IL-4、IL-13水平均较术前升高,IL-2、INF-γ水平均较术前降低(均 P<0.05);HADAS组患者的S100β、MBP、NSE、IL-4、IL-13水平均明显高于对照组,IL-2、INF-γ水平均明显低于对照组(均 P<0.001)。术后1d 2组患者的MMSE、MoCA量表评分均明显低于术前(均 P<0.05),且HADAS组患者MMSE、MoCA量表评分均低于对照组(均 P<0.001)。 结论:高原股骨骨折合并HADAS患者较无HADAS者在全身麻醉术后短期内认知功能、血流动力学、脑神经功能损伤更甚,对于HADAS手术患者需谨慎选择麻醉方案。

ObjectiveTo investigate the impact of concurrent high-altitude osteoporotic femoral fracture and high-altitude de-acclimatization syndrome(HADAS)on intraoperative hemodynamics,cerebral neurologic function,and cognitive function in patients undergoing general anesthesia.MethodsAmong the patients underwent operation under general anesthesia in the Department of Orthopedics of Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region from March 2019 to March 2021,69 patients with concurrent high-altitude osteoporotic femoral fracture and HADAS(HADAS group)and 63 patients with simple high-altitude osteoporotic femoral fracture(control group)were selected as the research subjects.Intraoperative hemodynamic indexes of the two groups were recorded,such as heart rate(HR),mean artery pressure(MAP),and pulse oxygen saturation(SpO 2).Cerebral neurological function indexes,such as S100 protein(S100β),myelin basic protein(MBP),and neuron-specific enolase(NSE)were detected by radioimmunoassay.Inflammation-related indexes,such as interleukin(IL)-2,IL-4,IL-13,and interferon-gamma(IFN-γ)were detected by enzyme-linked immunosorbent assay(ELISA).Cognitive function was evaluated with the mini mental state examination(MMSE)scale and the Montreal cognitive assessment(MoCA)scale.ResultsThe HR,MAP,and SpO 2 of the two groups at T1(5 min after tracheal intubation)were lower than those at T0,respectively;those indexes at T2(after operation)were high than those at T1;the HR,MAP,and SpO 2 of the HADAS group at T1 and T2 were lower than those of the control group,at the corresponding time points(all P<0.05).After operation,the S100β,MBP,NSE,IL-4,and IL-13 in both groups were higher than those before operation,while IL-2 and INF-γin the two groups were lower than those before operation(all P<0.05);S100β,MBP,NSE,IL-4,and IL-13 in the HADAS group were significantly higher than those in the control group,while IL-2 and INF-γin the HADAS group were significantly lower than those in the control group(all P<0.001).On one day after operation(both P<0.001),MMSE scores and MoCA scores of the two groups were significantly lower than those before operation(both P<0.05),and the HADAS group had lower scores than the control group(both P<0.001).ConclusionCompared with the high-altitude osteoporotic femoral fracture patients without HADAS,the high-altitude osteoporotic femoral fracture patients with HADAS have worse cognitive function,hemodynamics,and cerebral neurological function in the immediate postoperative period after general anesthesia.Therefore,cautious selection of anesthesia is needed for the patients with HADAS.