摘要
目的 评价老年全身麻醉患者血清脂联素（adiponectin,ADP）及基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）水平与术后认知功能障碍（postoperation cognitive dysfunction,POCD）的关系.方法 择期全身麻醉下行全髋关节置换术老年患者98例,年龄65岁～83岁,美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级,性别不限.所有患者分别于手术前3d及术后1、2、3、7d采用蒙特利尔认知评估表（montreal cognitie assessment,MoCA）评估认知功能,并采集空腹静脉血标本测定血清ADP及MMP-9水平.根据术后3d是否发生POCD分为POCD组和无POCD组.结果 28例患者发生POCD,发生率为28.5％,POCD组患者术后1、2、3d及7d血清MMP-9水平[（537±68）、（481±64）、（432±64）、（393±48） μg/L]较术前[（293±50） μg/L]明显升高（P＜0.05）,血清ADP水平[（4.3±1.6）、（4.7±1.2）、（5.1±1.6）、（6.0±1.1） mg/L]较术前[（9.39± 1.36） mg/L]明显下降（P＜0.05）.无POCD组术后1、2d血清MMP-9水平较术前明显升高（P＜0.05）,血清ADP水平较术前明显下降,术后3d均恢复至术前水平.组间比较,POCD组术后各时间血清MMP-9水平明显高于无POCD组[（439±53）、（387±66）、（301±67）、（296±54）μg/L]（P＜0.05）;而ADP水平均明显低于无POCD组[（5.7±1.0）、（6.7±1.4）、（9.1±1.0）、（9.4±1.2）mg/L] （P＜0.05）.直线相关分析：POCD组患者血清MMP-9水平与MoCA评分呈负相关（r=-0.833,P＜0.01）,ADP水平与MoCA评分呈正相关（r=0.513,P＜0.01）.结论 老年全麻患者术后血清ADP水平下降与MMP-9水平升高可能参与了POCD发生的病理生理过程.
Objective To evaluate the reIationship of the serum levels of adiponectin （ADP）,matrix metalloproteinase-9 （MMP-9） and postoperative cognitive dysfunction （POCD） in elderly patients after general anesthesia.Methods Ninety eight ASA Ⅰ or Ⅱ patients,aged 65 y-83 y,scheduled for artificial hip replacement under general anesthesia were studied.Cognitive functionwas assessed by Montreal Cognitie Assessment （MoCA）,at 3 d before the operation and 1,2,3 d and 7 d after operation,and venous blood samples were collected for determination of serum ADP and MMP-9 levels at the same time in all patients.Patients were divided into POCD group and non-POCD group according to the occurrence of POCD in 3 d after operation.Results Twenty eight patients developed POCD （28.5%）.Compared with the preoperative levels （293±50） μg/L,the serum levels of MMP-9 [（537±68）,（481±64）,（432±64）,（393±48） μg/L] were significantly increased at 1,2,3 d and 7 d after operation,and the serum levels of ADP [（4.3±1.6）,（4.7±1.2）,（5.1±1.6）,（6.0±1.1） mg/L] were significantly declined at 1,2,3 d and 7 d after operation compared with the preoperative levels （9.39±1.36） μg/L in group POCD （P〈0.05）.Compared with that of preoperation,the serum levels of MMP-9 were significantly increased,and the serum levels of ADP were significantly declined on 1,2 d in group non-POCD.The serum levels of MMP-9 in group POCD,were significantly higher than that in group non-POCD [（439±53）,（387±66）,（301± 67）,（297±54） μg/L]（P〈0.05） at 1,2,3,7 d after operation.Compared with group POCD,the serum levels of ADP [（5.7±1.0）,（6.7±1.4）,（9.1±1.0）,（9.34±1.2） mg/L] were significanfly higher in group non-POCD （P〈0.05） at 1,2,3,7 d after operation.Correlation analysis showed that the serum levels of MMP-9 were negatively correlated with MoCA score （r=-0.833,P〈0.01）,the serum 1evels of ADP were positively correlated with MoCA score （r=0.513,P〈0.01）.Conclusions An decreased postoperative serum ADP level and an increased postoperative serum MMP-9 level may be involved in the pathophysiological process of POCD in elderly patients with general anesthesia.
出处
《国际麻醉学与复苏杂志》
CAS
2015年第4期306-309,共4页
International Journal of Anesthesiology and Resuscitation
基金
东莞市科技计划医疗卫生类科研项目（20131051010086）
