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

目的研究髋关节置换术老年患者血清白介素-6（IL一6）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％ vs 22％，P〈0．05），术后6h、1d点POCD发生率与E组相似（27％ VS 17％、20％ vs 11％，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-67水平明昂高于无POCD者（P〈0．01）。结论髋关节置换术老年患者行伞麻后早期POCD的发牛率较高可能与IL-6的升高有关。

Study on the relationship between serum interleukin-6 (IL-6) levels and early postoperative cognitive dysfunction (POCD) in elderly patient undergoing hip joint replacement

Objective To investigate the relationship with levels of serum interleukin-6 and early POCD in elderly patients undergoing hip joint replacement.Methods 33 elderly patients undergoing selective hip joint replacement with ASA physical status II were randomly divided into two groups:group G and group E.Patients in group G received combined intravenous-inhalation anesthesia and endotracheal intubation.Patients in group E received combined spinal-epidural anaesthesia.No premedication was given before surgery.Intraoperative shrink blood pressure(SBP)was maintained within 25% of baseline value and pulse oxygen saturation(SpO2)kept above 95%.Intravenous fentanyl(0.001%,2ml/h)provided 48h postoperative analgesia.MMSE scores were recorded before anesthesia or at 3h,6h,1d,and 3d after operation.The cervical venous blood samples were obtained before anesthesia or at 3h and 6h after operation for detecting the levels of serum IL-6.Results Compared with preoperation,MMSE scores in all the patients decreased significantly at 3h,6h and 1d after operation(P<0.01),and returned to preoperative levels at 3d after surgery.MMSE scores were significantly lower in group G at 3h and 6h after operation than those in group E(P<0.05).The incidence of POCD in group G is 67%,27%,20% at 3h,6h and 1d after operation,and in group E is 22%,17%,11% respectively.The incidence of POCD was significantly higher in group G than that in group E at 3h after operation(P<0.05).Serum IL-6 levels in all the patients were significantly decreased at 3h and 6h after operation(P<0.01).Serum IL-6 levels was significantly higher in group G than that in group E at 3h,6h after operation(P<0.01).The decrement in serum IL-6 was greater in 14 patients experienced POCD than those without POCD at 3h and 6h after operation(P<0.01).Conclusions The high incidence of early POCD in elderly patients undergoing selective hip joint replacement is associated with general anesthesia which maybe relevant with the levels of serum IL-6.