摘要
目的探讨术前血浆炎性因子C1q、C3b及神经颗粒素与老年肺叶切除术患者术后谵妄(POD)的关系。方法择期全身麻醉下行胸腔镜肺叶切除术的老年患者94例,男53例,女41例,年龄≥65岁,ASAⅠ-Ⅲ级,根据是否发生POD将患者分为两组:POD组和非POD组。于术前24 h行简易智力状态检查量表(MMSE)评分并抽外周血检测血浆C1q、C3b与神经颗粒素浓度;术后第1~3天采用混乱评估法对患者进行POD评估。采用受试者工作特征(ROC)曲线分析炎性因子预测POD的效能。结果有21例患者(22.3%)发生POD(POD组)。POD组术前血浆C1q、C3b、神经颗粒素浓度明显高于非POD组(P<0.05),住院时间明显长于非POD组(P<0.05),术前MMSE评分明显低于非POD组(P<0.05)。术前血浆C1q、C3b及神经颗粒素预测POD的曲线下面积分别为0.89(0.78~0.99)、0.87(0.79~0.96)及0.89(0.80~0.98)(P<0.05)。结论POD患者术前血浆C1q、C3b及神经颗粒素浓度明显升高,因而通过监测这些指标可能对POD早期诊断与防治有一定价值。
Objective To investigate the association between plasma levels of cytokines and neurogranin and the incidence of postoperative delirium(POD)in elderly patients undergoing pulmonary lobectomy.Methods Ninty-four patients scheduled for pulmonary lobectomy,53 males and 41 females,aged≥65 years,falling into ASA physical statusⅠ-Ⅲ,were divided into two groups according to whether POD occurred:POD group and non-pod group.Mini-mental state examination(MMSE)was used to assess cognitive performance,and blood was obtained to measure plasma levels of cytokines(C1q and C3b)and synaptic related proteins(neurogranin)24 h before surgery.POD was diagnosed daily for 3 d postoperatively by the confusion assessment method.The receiver operating characteristic(ROC)curve was used to analyze inflammatory factors to predict POD performance.Results The incidence of POD was 22.3%(21/94).Compared with non-POD group,there was significantly prolonged hospital stay but lower preoperative MMSE scores in POD group(P<0.05).There were also significantly higher preoperative plasma levels of C1q and C3b and neurogranin in POD group than those in non-POD group(P<0.05).The areas under the ROC curves of preoperative C1q,C3b,and neurogranin for predicting POD were 0.89(0.78-0.99),0.87(0.79-0.96),and 0.89(0.80-0.98),respectively.Conclusion Plasma levels of C1q and C3b and neurogranin are higher in POD patients,thus may be helpful for early diagnosis and prevention of POD.
作者
鲁振
高蓉
LU Zhen;GAO Rong(Department of Anesthesiology,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2019年第10期945-947,共3页
Journal of Clinical Anesthesiology
关键词
肺叶切除术
老年患者
术后请妄
补体
神经颗粒素
Pulmonary lobectomy
Elderly patients
Postoperative delirium
Complement
Neurogranin
