脊髓外科手术患者术后精神障碍与神经递质的相关性研究

A Study on the Correlation Between Postoperative Mental Disorders and Neurotransmitters in Patients Undergoing Spinal Cord Surgery

目的探讨脊髓术后精神障碍发生和神经递质的相关性,为有效干预提供依据。方法按照纳入排除标准随机抽取2021年10月至2022年12月在我院完成脊髓外科手术发生(研究组)和未发生(对照组)精神障碍的患者各20例作为研究对象。采集患者的空腹静脉血及脑脊液进行神经递质检测;采用汉密尔顿焦虑(HAMA)、抑郁(HAMD)量表及Richmond躁动-镇静评分(RASS)进行问卷调查。统计分析神经递质水平与问卷得分的相关性。结果本研究结果显示,发生精神障碍的患者术后24 h血液及脑脊液5-羟色胺(5-HT)、多巴胺(DA)、γ-氨基丁酸(GABA)、去甲肾上腺素(NE)水平较术前均明显下降,皮质醇(Cor)水平明显升高,而随着时间增加,5-HT、DA、GABA、NE水平逐渐增高、Cor逐渐降低(均P<0.001);术后24 h、3 d、1周及1月时两组患者血液及脑脊液中5-HT、DA、GABA、NE、Cor比较,差异均有统计学意义(P<0.05)。发生精神障碍患者术后HAMA、HAMD及RASS评分均较术前明显升高。相关性分析显示,患者HAMA评分与血液、脑脊液中5-HT、DA、NE水平均呈负相关,与血液、脑脊液中Cor水平均呈正相关(均P<0.05);患者HAMD评分与血液、脑脊液中5-HT、GABA、DA、NE水平均呈负相关,与血液、脑脊液中Cor水平均呈正相关(均P<0.05)。结论脊髓外科手术发生精神障碍和神经递质水平有较为显著的关联,一方面可能和术后忧郁导致神经递质改变,也可能和脊髓损伤、术后应激均有关联,具体机制还需要深入研究。

Objective To explore the correlation between postoperative mental disorders and neurotransmitters in spinal cord surgery,and provide a basis for effective intervention.Methods 20 patients who underwent spinal surgery in our hospital from October 2021 to December 2022 and developed mental disorders(research group)and 20 patients who did not develop mental disorders(control group)were randomly selected according to inclusion and exclusion criteria for the study.Fasting venous blood from patients for neurotransmitter testing was collected;A questionnaire survey was conducted using the Hamilton anxiety and depression scale and the richmond anxiety sedation scale.Statistical methods were used to analyze the levels of neurotransmitters between groups,questionnaire scores,and their correlation.Results The results of this study showed that postoperative Hamilton anxiety,depression,and Richmond restlessness sedation scores were significantly higher in patients with mental disorders compared to preoperative levels;In patients with cognitive impairment,the levels of 5-hydroxytryptamine(5-HT),dopamine(DA),γ-aminobutyric acid(GABA)and norepinephrine(NE)decreased significantly 24 hours after operation,while the level of cortisol(Cor)increased significantly.With the increase of time,the levels of 5-HT,DA,GABA and NE gradually increased and Cor decreased gradually(P<0.05).There were significant differences in 5-HT,DA,GABA,NE and Cor in blood and cerebrospinal fluid between the two groups at 24 hours,3 days,1 week and 1 month after operation,all P<0.05;The correlation analysis showed that the HAMA score was negatively correlated with the levels of 5-HT,DA and NE in blood and cerebrospinal fluid,and positively correlated with the levels of Cor in blood and cerebrospinal fluid,all P<0.05.The HAMD score was negatively correlated with the levels of 5-HT,GABA,DA and NE in blood and cerebrospinal fluid,and positively correlated with the level of Cor in blood and cerebrospinal fluid,all P<0.05.Conclusion There is a significant correlation between mental disorders and neurotransmitter levels in spinal cord surgery.On the one hand,it may be related to postoperative depression leading to changes in neurotransmitters,as well as spinal cord injury and postoperative stress.The specific mechanism still needs further research.The authors will conduct preoperative and postoperative neurotransmitter intervention on spinal cord surgery animals in the future to clarify the deep relationship between mental disorders and neurotransmitters in spinal cord surgery.