CAJ | 학술논문

目的：探讨全髋关节置换术患者术后认知功能障碍(POCD)的发生与围术期血浆皮质醇水平的关系。方法选择90例在全麻下接受择期单侧全髋关节置换术的老年患者,年龄65~75岁,应用简易精神状态量表(MMSE)对患者的认知功能进行评定,根据是否发生 POCD 分为 POCD组和非 POCD 组。检测患者术前2 d、术后2、7 d 血浆皮质醇水平。结果髋关节置换术老年患者术后7 d POCD 发生率为37.8%；与术前2 d 比较,POCD 组患者术后2、7 d 血浆皮质醇水平明显增高(P <0.01或 P <0.05)；与非 POCD 组比较,POCD 组患者术后2、7 d 血浆皮质醇水平明显增高(P <0.05)。两组患者术后2、7 d 血浆皮质醇水平与 MMSE 评分呈负相关(P <0.01)。结论老年患者全髋关节置换术后早期的 POCD 发生率较高,术后血浆皮质醇水平升高可能与 POCD 的发生有关。
목적：탐토전관관절치환술환자술후인지공능장애(POCD)적발생여위술기혈장피질순수평적관계。방법선택90례재전마하접수택기단측전관관절치환술적노년환자,년령65~75세,응용간역정신상태량표(MMSE)대환자적인지공능진행평정,근거시부발생 POCD 분위 POCD조화비 POCD 조。검측환자술전2 d、술후2、7 d 혈장피질순수평。결과관관절치환술노년환자술후7 d POCD 발생솔위37.8%；여술전2 d 비교,POCD 조환자술후2、7 d 혈장피질순수평명현증고(P <0.01혹 P <0.05)；여비 POCD 조비교,POCD 조환자술후2、7 d 혈장피질순수평명현증고(P <0.05)。량조환자술후2、7 d 혈장피질순수평여 MMSE 평분정부상관(P <0.01)。결론노년환자전관관절치환술후조기적 POCD 발생솔교고,술후혈장피질순수평승고가능여 POCD 적발생유관。
Objective To investigate the relationship between postoperative cognitive dysfunc-tion and plasma cortisol levels in aged patients undergoing total hip replacement surgery. Methods Ninety patients aged 65-75 years old,scheduled for total hip replacement surgery under general anesthesia were enrolled in the present study.Cognitive state was tested by mini-mental state examination (MMSE).The patients were divided into two groups,POCD group and non-POCD group.Perioperative plasma levels of cortisol were determined on 2 d preoperative,2 d postoperative and 7 d postoperative.Results Incidence of POCD after 7 d in aged patients undergoing total hip re-placement surgery was 37.8%.Compared with day 2 d preoperative,plasma cortisol levels in POCD patients significantly increased on 2 d and 7 d post operation (P <0.01 or P <0.05).Compared with non-POCD patients,cortisol levels on the 2 d and 7 d postoperative day significantly increased in POCD patients (P <0.05).Plasma cortisol levels showed a negative correlation with MMSE scores on postoperative 2 d and 7 d(P <0.01).Conclusion Elderly patients have a relatively higher incidence of POCD after hip replacement surgery.POCD may be caused by high plasma cortisol levels in elderly patients following hip replacement surgery under general anesthesia.