不同镇静深度介导PI3K/Akt信号通路对老年患者术后认知功能的影响研究被引量：3

Study of effects of different depth of sedation mediated PI3K/AKT signaling pathway on cognitive function in elderly patients after surgery

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摘要目的观察不同镇静深度对老年下肢矫形手术患者术后认知功能及脑脊液中PI3K/Akt信号通路的影响。方法根据不同镇静深度指数（CSI）,将行下肢矫形手术ASAⅠ~Ⅱ级老年患者70例分为CSI-50组35例和CSI-80组35例。在术前1 d及术后3,7 d使用术后恢复质量评估量表（PQRS）新认知评价体系评估患者的认知功能水平。利用蛋白免疫印迹法（Western blotting）检测2组患者蛛网膜下腔穿刺置管成功后（t0）、插入喉罩后即刻（t1）及手术后6 h（t2）、24 h（t3）和48 h（t4）脑脊液中PI3K、Akt、p Akt、bcl、bax的浓度。结果术后2组患者认知功能均出现降低,CSI-50组变化较CSI-80组明显;2组术后7 d MMSE评分恢复正常,而PQRS评分则显示患者仍存在认知功能缺损;PQRS评分显示术后POCD发生率明显高于MMSE评分。Western blotting结果显示,2组t1、t2、t3及t4时间点PI3K、p Akt、bcl水平均明显低于t0时（P均〈0.05）,而bax水平明显高于t0时（P均〈0.05）,且t1~t4时间点各指标水平CSI-50组均明显低于CSI-80组（P均〈0.05）。结论镇静深度对老年下肢矫形手术患者术后认知功能有不同程度影响,其影响机制可能与介导PI3K/Akt信号通路的标志性蛋白表达水平有关。 Objective It is to observe the effects of different depth of sedation on postoperative cognitive function in elderly patients with lower limbs orthopedic operation,and to discuss the influence on PI3 K / AKT signal pathway in the cerebrospinal fluid. Methods 70 cases of elderly patients with lower limbs orthopedics ASA Ⅰ ~ Ⅱ grade were divided into CSI- 50 group（ 35 cases） and the CSI- 80 group（ 35 cases） according to the different depth of sedation. On 1 d before,3 d and 7 d after operation,the new cognitive evaluation system in postoperative recovery Physician Quality Reporting System（ PQRS） was used to assess the cognitive function levels of the patients. The concentrations of PI3 K,AKT,p AKT,Bcl and Bax in cerebrospinal fluid were determined by Western blotting after the success of the subarachnoid puncture catheter（ t0）,insert a laryngeal mask immediately（ t1）,6 h（ t2）,24 h（ t3）,48 h（ t4） after operation. Results The scores of postoperative cognitive function of the patients of the two groups both reduced,and the changes of CSI- 50 group were more obviously than that of CSI- 80 group.The MMSE scores became normal in both groups in 7 d after operation,while the PQRS scores showed that the patients still had postoperative cognitive function dysfunction（ POCD）,the incidence of POCD evaluated by PQRS scores was higher than that evaluated by MMSE scores. Western blotting results showed that the levels of PI3 K,p AKT,Bcl at t1,t2,t3,and t4 were higher while that of bax was lower than those at t0（ P〈0. 05）,and every index at t1- t4 was lower in CSI- 50 group than that in CSI- 80 group（ P〈0. 05）. Conclusion Different depth of sedation had more or less effects on the postoperative cognitive function in elderly patients with lower limbs orthopedic operation,the impact mechanism may be related to the mediation on iconic protein expression levels of PI3 K / AKT signal pathway.

作者李小宝杨志星吴翼南周敬民赵志虎刘香珠邹毅清

机构地区南京军区福州总医院福建医科大学福总临床医学院

出处《现代中西医结合杂志》 CAS 2016年第13期1369-1371,1381,共4页 Modern Journal of Integrated Traditional Chinese and Western Medicine

基金福建省科技厅重点项目(2012Y0059) 南京军区重点课题(13ZD38)

关键词镇静深度认知功能术后 PI3K/AKT信号通路 different depth of sedation cognitive function postoperation PI3K / AKT signaling pathway

分类号 R614.2 [医药卫生—麻醉学]

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