老年髋关节手术患者围麻醉期脑氧饱和度对术后认知功能障碍及炎症反应影响的研究

Study on the impact of cerebral oxygen saturation on postoperative cognitive dysfunction and inflammatory response in elderly patients undergoing hip surgery during perioperative anesthesia

目的探究老年髋关节手术患者围麻醉期局部脑氧饱和度对术后认知功能障碍及炎症的反应影响。方法收集接受髋关节置换术治疗的老年患者120例,设定围麻醉期局部脑氧饱和度(regional saturation of cerebral oxygenation,rScO_(2))降低幅度大于术前20%为脑缺氧,根据患者术中rScO_(2),将患者分为缺氧组和非缺氧组,其中非缺氧组63例,缺氧组57例。使用简易智力状态检查量表(mini-mental state examination,MMSE)、蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)评估患者术前及术后认知水平;统计分析rScO_(2)与MMSE、MoCA的相关性;利用ELISA检测患者术前后血浆神经元特异性烯醇化酶(neuron specific enolase,NSE)、S100-β蛋白、肿瘤坏死因子α(tumor necrosis factor,TNF-α)、白细胞介素6(interleukin,IL-6)水平;检测患者外周血白细胞、中性粒细胞数量。结果非缺氧组和缺氧组rScO_(2)随时间增加先降低后升高,组间、时点间、组间·时点间交互作用比较差异均有统计学意义(P<0.05)。术前2组间MMSE、MoCA评分,血浆NSE、S100-β、TNF-α、IL-6水平,外周血白细胞、中性粒细胞数量差异无统计学意义(P>0.05);缺氧组术后MMSE、MoCA评分显著低于非缺氧组(P<0.05);Spearman相关性分析显示,麻醉期rScO_(2)水平与患者MMSE、MoCA评分呈正相关(P<0.05)。缺氧组术后血浆NSE、S100-β、TNF-α、IL-6水平及外周血白细胞、中性粒细胞数量显著高于非缺氧组(P<0.05)。结论围麻醉期局部脑氧饱和度不足会促进老年髋关节手术患者术后认知功能障碍及免疫功能紊乱,本研究为临床老年髋关节手术患者麻醉期局部脑氧饱和度控制提供了参考。

Objective To explore the effect of cerebral oxygen saturation on postoperative cognitive dysfunction and inflammation in elderly patients undergoing hip surgery during perioperative anesthesia.Methods A total of 120 elderly patients undergoing hip arthroplasty were collected,and the decrease in regional saturation of cerebral oxygen(rScO_(2))during perioperative anesthesia was set to be greater than 20%before surgery as cerebral hypoxia.According to the intraoperative rScO_(2),the patients were divided into hypoxia group(n=57)and non-hypoxia group(n=63).The preoperative and postoperative cognitive levels of patients were assessed using the Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA)Scale score.Statistical analysis of the correlation of rScO_(2)with MMSE and MoCA was performed.ELISA was used to detect neuron specific enolase(NSE),S100-β protein,tumor necrosis factorα(TNF-α),and interleukin-6(IL-6)levels in the plasma of patients before and after surgery.The number of white blood cells(WBCs)and neutrophils in peripheral blood of the patients was measured.Results The rScO_(2) in the non-hypoxia group and the hypoxia group firstly decreased and then increased with the increase of time,and there were significant differences in interaction between groups,time points,and time points between groups(P<0.05).There were no significant differences in MMSE,MoCA scores,plasma NSE,S100-β,TNF-α,IL-6 levels,peripheral blood WBC and neutrophil counts between the two groups before surgery(P>0.05).The scores of MMSE and MoCA in the hypoxia group were significantly lower than those in the non-hypoxia group(P<0.05).Spearman correlation analysis showed that rScO_(2) level during anesthesia was positively correlated with MMSE and MoCA scores.The levels of plasma NSE,S100-β,TNF-α,IL-6 as well as peripheral blood WBC and neutrophil counts in the hypoxia group were significantly higher than those in the non-hypoxia group(P<0.05).Conclusion Insufficient cerebral oxygen saturation during perioperative anesthesia can promote postoperative cognitive dysfunction and immune dysfunction in elderly patients undergoing hip surgery.This study provides a reference for the control of cerebral oxygen saturation during perioperative anesthesia in elderly patients undergoing hip surgery.