文章摘要
肌少症与老年髋部手术患者术后认知功能下降的相关性
Correlation between sarcopenia and postoperative cognitive function decline in elderly patients undergoing hip surgery
  
DOI：10.12089/jca.2022.08.003
中文关键词: 肌少症  老年  髋部手术  认知功能
英文关键词: Sarcopenia  Elderly  Hip surgery  Cognitive function
基金项目:2019年度安徽省高校自然科学研究重点项目（KJ2019A1111）；2019年度安徽医科大学校科研基金项目（2019xkj246）
作者单位E-mail
江涛 230041,合肥市,安徽省第二人民医院麻醉科  
汪平娟 230041,合肥市,安徽省第二人民医院麻醉科  
梁向南 230041,合肥市,安徽省第二人民医院麻醉科  
樊松 230041,合肥市,安徽省第二人民医院影像科  
魏巍 230041,合肥市,安徽省第二人民医院影像科  
王义桥 230041,合肥市,安徽省第二人民医院麻醉科 309734607@qq.com 
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中文摘要:
      
目的 探讨肌少症与老年髋部手术患者术后认知功能下降的相关性。
方法 选择2020年1月至2021年4月择期行髋部手术的老年患者126例，男47例，女79例，年龄65～89岁，BMI 18～24 kg/m2，ASA Ⅱ或Ⅲ级。通过第12胸椎水平骨骼肌肌肉质量指数（SMI），根据肌少症的诊断标准（男性：SMI<42.6 cm2/m2、女性：SMI<30.6 cm2/m2），将患者分为两组：肌少症组（S组，n=41）和对照组（C组，n=85）。于术前1 d和术后第7天进行神经心理学测试，根据可信改变指数（RCI）>1.65判定该项神经心理学测试成绩异常下降，2项及以上神经心理学测试成绩异常下降可认定该患者认知功能下降。记录一般情况、术前检验结果、神经心理学测试成绩和出现术后认知功能下降例数，采用分层分析明确肌少症与术后认知功能下降的关系。
结果 术后第7天发生认知功能下降共有27例（21.4%），其中S组有15例（36.6%），C组有12例（14.1%）。与C组比较，S组BMI和体重明显降低（P<0.05），术前超敏C反应蛋白（hs-CRP）浓度明显增加（P<0.05）。与术前1 d比较，S组在术后第7天数字符号测试、循迹连线测试和画钟测试中成绩明显下降（P<0.05）。分层分析结果显示，年龄>85岁（RR=2.70，95%CI 1.16～6.29，P<0.05）、BMI<20 kg/m2（RR=2.86，95%CI 1.26～6.46，P<0.05）、ASA Ⅲ级（RR=4.63，95%CI 1.38～15.55，P<0.05）、受教育程度<5年（RR=5.63，95%CI 2.48～12.78，P<0.05）和术前hs-CRP>8 mg/L（RR=4.09，95%CI 1.05～15.94，P<0.05）的患者中肌少症与术后认知功能下降有关。
结论 在行髋部手术的老年患者中，合并肌少症的患者术后认知功能下降与年龄>85岁、BMI<20 kg/m2、ASA Ⅲ级、受教育程度<5年和术前hs-CRP>8 mg/L有关。
英文摘要:
      
Objective To investigate the correlation between sarcopenia and postoperative cognitive function decline in elderly patients undergoing hip surgery.
Methods A total of 126 elderly patients undergoing elective hip surgery from January 2020 to April 2021 were selected, 47 males and 79 females, aged 65-89 years, BMI 18-24 kg/m2, ASA physical status Ⅱ or Ⅲ. Based on the skeletal muscle mass index (SMI) at level of the 12th thoracic vertebra, together with the diagnostic criteria of sarcopenia (SMI < 42.6 cm2/m2 in male, SMI < 30.6 cm2/m2 in female), patients were divided into two groups: sarcopenia group (group S, n = 41) and control group (group C, n = 85). Neuropsychological tests were performed 1 day before surgery and on the seventh day after surgery. Reliable change index (RCI) > 1.65 indicates an abnormal decrease in this test. Patients with two or more abnormal decline in the neuropsychological test were identified to have cognitive decline. General conditions, preoperative test results, neuropsychological test scores and the number of presenting postoperative cognitive function decline were recorded. Stratified analysis was used to determine the correlation between sarcopenia and postoperative cognitive function decline.
Results There were 27 patients (21.4%) showed cognitive decline on the seventh day after surgery, including 15 patients (36.6%) in group S and 12 patients (14.1%) in group C. Compared with group C, the BMI and weight of group S were significantly decreased, and the hypersensitive C-reactive protein before surgery was significantly increased in group S (P < 0.05). Compared with the test performance 1 day before surgery, the cognitive function of group S demonstrated in the numeric symbol test, tracer linking test and clock drawing test on the seventh day after surgery significantly decreased (P < 0.05). The stratified analysis indicated that in the patients with aged > 85 years (RR = 2.70, 95% CI 1.16-6.29, P < 0.05), BMI < 20 kg/m2(RR = 2.86, 95% CI 1.26-6.46, P < 0.05), ASA physical status Ⅲ (RR = 4.63, 95% CI 1.38-15.55, P < 0.05), education less than five years (RR = 5.63, 95% CI 2.48-12.78, P < 0.05)and preoperative hs-CRP > 8 mg/L (RR = 4.09, 95% CI 1.05-15.94, P < 0.05), sarcopenia was related to the postoperative cognitive function decline.
Conclusion In elderly patients undergoing hip surgery, the postoperative cognitive function decline of patients with sarcopenia are correlated to aged >85 years, BMI <20 kg/m2, ASA physical status Ⅲ, education less than five years and preoperative hs-CRP >8 mg/L.
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