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術後炎性反應在老年體外循環心臟手術患者認知功能下降中的作用:一項前瞻性對照研究


麻醉MG溫馨提示:本平台已開通文章搜索功能,可關注後發送關鍵詞體驗。背景與目的非感染性炎性反應(IR)在術後認知功能障礙(POCD)發病病因中的作用仍然存在爭議。這項前瞻性對照研究...

- 2018年6月30日16時53分
- 科學文摘 / 麻醉MedicalGroup

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溫馨提示:本平台已開通文章搜索功能,可關注後發送關鍵詞體驗。

背景與目的

非感染性炎性反應(IR)在術後認知功能障礙(POCD)發病病因中的作用仍然存在爭議。這項前瞻性對照研究的目的在於評估心臟手術中以血清降鈣素原(PCT)改變來定義的IR程度和POCD進展之間的關係。


方 法

本研究納入年齡≥60歲,擇期心臟手術的42例患者。根據術後第一天測得PCT結果隨機分為低炎性反應組(LIR)和高炎性反應組(HIR)。從基層醫療機構中納入了一個相匹配的含有32名受試者的規範性對照組。術後五天內每天監測PCT和C反應蛋白(CRP)水平。術前和術後第七天進行五項神經認知功能測試和兩項情緒測試。使用規範的對照組數據得出的改良可信改變指數(RCIP)來確定效能是否顯著下降。

結 果

LIR組(n = 20)和HIR組(n= 22)的PCT存在顯著差異(P<0.001),但與CRP的改變時點不一致。在隊列中術後第一周POCD的發生率為35.7%。LIR和HIR組的神經認知功能測試RCIP

Z分數和POCD發生機率結果均沒有統計學差異(分別為7和8例,P>0.05)。此外,情緒狀態評分、焦慮水平等已知圍術期影響POCD發生的因素也均沒有統計學差異。

結論:這項研究表明,在體外循環心臟手術中非感染性炎性反應對老年患者術後早期POCD的發生不產生影響


結 論

這項研究表明,在體外循環心臟手術中非感染性炎性反應對老年患者術後早期POCD的發生不產生影響。

原始文獻摘要

Nemeth E, Vig K, Racz K, et al. Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery: a controlled, prospective

observational study. Bmc Anesthesiology, 2017, 17(1):113.

Background: The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled,

prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery.

Methods: Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups

based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP)

levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories

and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test

performance.


Results: The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p < 0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was

35.7% in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05).Additionally, there was no

difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD.

Conclusions: In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative

period in elderly patients.

翻譯:郭唯真 來源: 罌粟花

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