文章摘要
老年患者髋关节置换术后谵妄的危险因素
Risk factors for delirium after hip replacement in elderly patients
  
DOI：10.12089/jca.2022.07.003
中文关键词: 前列腺素E2  术后谵妄  认知功能  髋关节置换术  老年  危险因素
英文关键词: Prostoglandin E2  Postoperative delirium  Cognition function  Hip replacement  Aged  Risk factors
基金项目:“六大人才高峰”资助项目（WSW-002）；“青年医学人才”资助项目（QNRC2016822）
作者单位E-mail
王标 210011,南京医科大学第二附属医院麻醉科  
王雷原 210011,南京医科大学第二附属医院麻醉科  
纪木火 210011,南京医科大学第二附属医院麻醉科 jimuhuo2009@sina.com 
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中文摘要:
      
目的 探讨老年患者髋关节置换术后谵妄（POD）的危险因素。
方法 选择2020年10月至2021年9月择期行髋关节置换术老年患者121例，男55例，女66例，年龄65～84岁，BMI 18～28 kg/m 2，ASA Ⅰ—Ⅲ级。术后3 d内采用中文版意识模糊评估量表评估患者POD发生情况。根据患者是否发生POD将患者分为两组：POD组和非POD组。记录性别、年龄、BMI、ASA分级、术前简易智能状态评价量表评分（MMSE评分）、术前合并症（高血压、冠心病、糖尿病、脑梗死、慢性阻塞性肺疾病等）、手术时间和术中失血量等。麻醉诱导前抽取外周血5 ml，采用ELISA法检测血清白细胞介素-17A（IL-17A）、白细胞介素-33（IL-33）、诱导型一氧化氮合酶（iNOS）、前列腺素E2（PGE2）、补体3a（C3a）、补体3（C3）、补体5a（C5a）、中枢神经特异性蛋白（S100β）、神经胶质酸性蛋白（GFAP）、神经纤维丝轻链（NFL）、脑源性神经营养因子（BDNF）、成纤维细胞生长因子-23（FGF-23）、鸢尾素（irisin）、Ⅰ型血管细胞黏附蛋白（VCAM-1）、选择素E（E-selectin）和基质金属蛋白酶（MMP-9）浓度。采用单因素和多因素Logistic回归分析POD危险因素，并根据独立危险因素绘制ROC曲线并计算曲线下面积（AUC）预测POD。
结果 有37例（30.6%）患者发生POD。与非POD组比较，POD组年龄明显增大，ASA分级明显升高，术前MMSE评分明显降低（P<0.05），血清iNOS、PGE2、S100β、GFAP和NFL浓度明显升高（P<0.05），血清irisin浓度明显降低（P<0.05）。多因素Logistic回归分析结果显示，PGE2升高是POD的独立危险因素（OR=1.051，95%CI 1.013～1.091，P=0.008）。血清PGE2浓度升高预测发生POD的AUC为0.922（95%CI 0.864～0.980，P<0.001），敏感性81.1%，特异性92.5%。
结论 术前血清PGE2浓度升高是老年患者髋关节置换术后谵妄的独立危险因素，对其发生具有较高的预测价值。
英文摘要:
      
Objective To investigate the risk factors for postoperative delirium (POD) after hip replacement in elderly patients.
Methods A total of 121 elderly patients scheduled for hip replacement surgeries were selected, 55 males and 66 females, aged 65-84 years, BMI 18-28 kg/m 2, ASA physical status Ⅰ-Ⅲ. The occurrence of POD was assessed by Chinese version of fuzzy consciousness scale within 3 days after surgery. Patients were divided into two groups based on whether they developed POD: POD group and non-POD group. Gender, age, BMI, ASA, preoperative mini-mental state examination score (MMSE score), preoperative complications (hypertension, coronary heart disease, diabetes, cerebral infarction, chronic obstructive pulmonary disease, etc), operative time and intraoperative blood loss were recorded. Peripheral blood 5 ml was extracted before anesthesia induction, and serum interleukin-17A (IL-17A), interleukin-33(IL-33), inducible nitric oxide synthase (iNOS), prostaglandin E2 (PGE2), complement 3a (C3a), complement 3 (C3), complement 5a (C5a), central nerve specific protein (S100β), glial acidic protein (GFAP), neurofibroid light chain (NFL), brain-derived neurotrophic factor (BDNF), fibroblast growth factor-23 (FGF-23), irisin, vascular cell adhesion protein-1(VCAM-1), selectin E (E-selectin) and matrix metalloproteinase-9 (MMP-9) concentrations were detected by ELISA. The risk factors of POD were analyzed by univariate and multivariate Logistic regression, and the ROC curve was drawn based on the independent risk factors, and the area under the curve (AUC) was calculated to predict POD.
Results There were 37 patients (30.6%) developing POD. Compared with non-POD group, age and ASA physical status were significantly increased (P < 0.05), and decreased MMSE scores in POD group (P < 0.05). Serum concentrations of iNOS, PGE2, S100β, GFAP and NFL were significantly increased while serum concentration of irisin was significantly decreased in POD group (P < 0.05). Multivariate logistic regression analysis showed that elevated PGE2 was an independent risk factor for POD (OR = 1.051, 95% CI 1.013-1.091, P = 0.008), with a sensitivity of 81.1% and a specificity of 92.5%.
Conclusion Preoperative serum PGE2 is a significant risk factor for POD after hip replacement in elderly patients, which has a high predicted value for POD.
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