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同型半胱氨酸水平对老年髋关节置换术后认知功能障碍的影响
作者:陈文东1  李玉梅2  高淑平3 
单位:1. 阳春市人民医院 麻醉科, 广东 阳春 529600;
2. 阳春市人民医院 心内科, 广东 阳春 529600;
3. 阳春市人民医院 检验科, 广东 阳春 529600
关键词:同型半胱氨酸 髋关节置换术 术后认知功能障碍 
分类号:R687.4;R749.2
出版年·卷·期(页码):2017·36·第九期(1313-1316)
摘要:

目的:评价血清同型半胱氨酸(Hcy)水平对老年髋关节置换术患者术后认知功能障碍(POCD)的影响。方法:选择拟在脊椎-硬膜外联合麻醉下行髋关节置换术患者100例,性别不限,年龄65~81岁,ASA分级Ⅱ或Ⅲ级。按血浆Hcy浓度分为3组:A组Hcy < 10μmol·L-1,42例;B组10μmol·L-1 ≤ Hcy < 20μmol·L-1,36例;C组Hcy ≥ 20μmol·L-1,22例。分别于术前1d (T0)及术后24h (T1)、72h (T2)、7d (T3)用MMSE评分表对患者进行认知功能评定。结果:与T0时间点比较,B、C组T1~T3时间点、A组T1和T2时间点MMSE评分降低(P<0.05或0.01);与A组比较,B、C组T1~T3时间点MMSE评分降低(P<0.05或0.01);与B组比较,C组T1~T3时间点MMSE评分降低(P<0.05或0.01);POCD发生率由高到低依次为C组 > B组 > A组(P<0.05或0.01)。结论:血清Hcy水平可影响老年髋关节置换术后认知功能,POCD的发生率与血清Hcy浓度正相关。

Objective: To evaluate the effect of serum homocysteine (Hcy) level on post-operative cognitive dysfunction (POCD) in elderly patients with hip arthroplasty. Methods: 100 elderly patients with hip joint replacement by the combined spinal epidural anesthesia were selected, male or female, aged from 65 to 81, ASA class Ⅱ or Ⅲ.According to plasma Hcy concentration, they were divided into three groups:group A Hcy < 10 μmol·L-1(n=42), group B 10 ≤ Hcy < 20μmol·L-1(n=36) and group C Hcy ≥ 20 μmol·L-1(n=22). The mimi-mental state examination(MMSE) was used to assess the cognitive function at 1d preoperation(T0)and 24h(T1), 72h(T2), 7d(T3) after the operation. Results: Compared with T0, the MMSE scores were decreased at T1-T3 time point in group B, C and T1, T2 time point in group A (P<0.05 or 0.01); Compared with group A,MMSE scores were decreased at T1-T3 in group B, C(P<0.05 or 0.01); Compared with group B,MMSE scores were decreased at T1-T3 in group C (P<0.05 or 0.01); The incidence of POCD from high to low was group C,group B, and group A in turn(P<0.05 or 0.01). Conclusion: Serum Hcy levels can affect cognitive function in elderly patients with hip arthroplasty. The incidence of POCD is positively correlated with serum Hcy concentration.

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