髋关节置换术老年患者血清IL-6水平与术后早期认知功能障碍的关系.doc

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1、髋关节置换术老年患者血清IL-6水平与术后早期认知功能障碍的关系作者：黄志莲李军连庆泉朱丽丹【摘要】目的研究髋关节置换术老年患者血清白介素-6(IL-6)水平与术后早期认知功能障碍的关系。方法33例择期髋关节置换术老年患者分全麻组(G组，静吸复合全麻)和腰硬组(E组，腰硬联合麻醉)。患者均未麻醉前用药，术中收缩压的变化维持在基础值±25%之内，SpO2≥95%。术后采用0.001%芬太尼（2ml/h）静脉48h镇痛。评估患者麻醉前，术后3、6h，1d和3d的MMSE评分。分别在麻醉前、术后3、6h采集右颈内静

2、脉血检测血清IL-6水平。结果老年患者术后3、6h，1d的MMSE评分较麻醉前明显降低(P<0.01)，术后3d基本恢复正常。G组术后3h点POCD发生率明显高于E组(67%vs22%，P<0.05)，术后6h、1d点POCD发生率与E组相似(27%vs17%、20%vs11%，P>0.05)。两组术后3、6h点IL-6水平均较麻醉前明显升高(P<0.01)，G组明显高于E组(P<0.01)，且14例POCD患者IL-6水平明显高于无POCD者(P<0.01)。结论髋关节置

3、换术老年患者行全麻后早期POCD的发生率较高可能与IL-6的升高有关。【关键词】老年髋关节置换术术后认知功能障碍白介素-6　　【Abstract】ObjectiveToinvestigatetherelationshipwithlevelsofseruminterleukin-6andearlyPOCDinelderlypatientsundergoinghipjointreplacement.Methods33elderlypatientsundergoingselectivehipjointreplace

4、mentwithASAphysicalstatusIIwererandomlydividedintotwogroups:groupGandgroupE.PatientsingroupGreceivedcombinedintravenous-inhalationanesthesiaandendotrachealintubation.PatientsingroupEreceivedcombinedspinal-epiduralanaesthesia.Nopremedicationwasgivenbeforesur

5、gery.Intraoperativeshrinkbloodpressure(SBP)wasmaintainedwithin25%ofbaselinevalueandpulseoxygensaturation(SpO2)keptabove95%.Intravenousfentanyl(0.001%,2ml/h)provided48hpostoperativeanalgesia.MMSEscoreswererecordedbeforeanesthesiaorat3h,6h,1d,and3dafteroperat

6、ion.Thecervicalvenousbloodsampleswereobtainedbeforeanesthesiaorat3hand6hafteroperationfordetectingthelevelsofserumIL-6.ResultsComparedwithpreoperation,MMSEscoresinallthepatientsdecreasedsignificantlyat3h,6hand1dafteroperation(P<0.01),andreturnedtopreoper

7、ativelevelsat3daftersurgery.MMSEscoresweresignificantlyloweringroupGat3hand6hafteroperationthanthoseingroupE(P<0.05).TheincidenceofPOCDingroupGis67%,27%,20%at3h,6hand1dafteroperation,andingroupE4is22%,17%,11%respectively.TheincidenceofPOCDwassignificantl

8、yhigheringroupGthanthatingroupEat3hafteroperation(P<0.05).SerumIL-6levelsinallthepatientsweresignificantlydecreasedat3hand6hafteroperation(P<0.01).SerumIL-6levelswassignificantlyhigheringroupGtha