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| 膝或髋关节置换术老年患者术前心房颤动与术后谵妄的关系 |
| Relationship between preoperative atrial fibrillation and postoperative delirium in elderly patients undergoing knee or hip replacement |
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| DOI：10.12089/jca.2026.04.008 |
| 中文关键词: 老年 心房颤动 术后谵妄 脑脊液 生物标志物 |
| 英文关键词: Aged Atrial fibrillation Postoperative delirium Cerebrospinal fluid Biomarkers |
| 基金项目: |
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| 中文摘要: |
目的： 探讨膝或髋关节置换术老年患者术前心房颤动（AF）和术后谵妄（POD）的关系。
方法： 选择2021年7月至2022年10月在腰-硬联合麻醉下接受膝或髋关节置换术的老年患者，年龄65～90岁，ASA Ⅰ—Ⅲ级。本研究中术前AF定义为入院前存在已确诊的AF史或入院后ECG检查诊断为AF。于术后7 d内或出院前采用意识模糊评估量表（CAM）诊断POD，根据POD的发生情况将患者分为两组：POD组和非POD组。采用酶联免疫吸附法（ELISA）检测脑脊液（CSF）中β淀粉样蛋白42（Aβ42）、总tau蛋白（T-tau）和磷酸化tau蛋白（p-tau）的浓度。采用多因素Logistic回归分析来筛选POD相关的危险因素。采用敏感性分析来评估多因素Logistic回归结果的可信度。采用中介效应分析脑脊液（CSF）生物标志物在术前AF与POD中的中介作用。
结果： 共纳入患者425例，有123例（28.9%）发生POD。多因素Logistic回归分析显示，在校正了性别、年龄、身高、糖尿病史、简易智力状态检查量表（MMSE）评分、输液量等多个混杂因素后，术前AF、CSF T-tau蛋白浓度升高、CSF p-tau蛋白浓度升高为POD发生的危险因素（P＜0.05），CSF中Aβ42浓度升高为POD发生的保护因素（P＜0.05）。中介效应分析显示，术前AF对POD的影响部分由CSF Aβ42蛋白降低介导（中介比例为25.8%）。
结论： 老年患者术前AF是POD的危险因素，CSF Aβ42蛋白的降低可能介导两者之间的关系。 |
| 英文摘要: |
Objective: To investigate the relationship between preoperative atrial fibrillation (AF) and postoperative delirium (POD) in elderly patients undergoing knee or hip replacement.
Methods: Elderly patients, aged 65-90 years, ASA physical status Ⅰ-Ⅲ, who underwent knee or hip replacement under combined spinal-epidural anesthesia between July 2021 and October 2022 were enrolled. Preoperative AF was defined as a history of previously diagnosed AF prior to admission or an AF diagnosis confirmed by ECG after admission. POD was diagnosed using the confusion assessment method (CAM) within 7 days after surgery or before discharge. Patients were divided into two groups accroding to the occurrence of POD: POD group and non-POD group. Concentrations of amyloid-β 42 (Aβ42), total tau protein (T-tau), and phosphorylated tau protein (p-tau) in cerebrospinal fluid (CSF) were measured by enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression was performed to identify risk factors for POD. Sensitivity analysis was used to evaluate the reliability of the regression results. Mediation analysis was conducted to assess the mediating role of CSF biomarkers in the association between preoperative AF and POD.
Results: A total of 425 patients were included, among whom 123 (28.9%) developed POD. After adjusting for multiple confounding factors including sex, age, height, history of diabetes mellitus, mini-mental state examination (MMSE) score, and infusion volume, multivariate logistic regression analysis showed that preoperative AF, elevated CSF T-tau concentration, and elevated CSF p-tau concentration were independent risk factors for POD (P < 0.05), while elevated CSF Aβ42 concentration was a protective factor against POD (P < 0.05). Mediation analysis revealed that the effect of preoperative AF on POD was partially mediated by reduced CSF Aβ42, with a mediation proportion of 25.8%.
Conclusion: Preoperative AF is a risk factor for POD in elderly patients undergoing knee or hip replacement, and decreased CSF Aβ42 may mediate the relationship between preoperative AF and POD. |
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