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-现代医学

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

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

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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