关节置换术患者血浆胆碱酯酶水平与术后认知功能障碍的相关性研究

目的：探讨关节置换术患者血浆胆碱酯酶（ChE）水平对发生术后认知功能障碍（POCD）的影响。方法选择2013年1~11月择期行膝关节、髋关节置换术患者82例，根据是否发生POCD分为POCD组32例（39.02%）和非POCD组50例（60.98%）。所有入选患者分别于术前1 d和术后1、3、5、7 d应用简易精神状态检查量表（MMSE）进行认知功能测定，并于术前1 d和术后1、3、5、7 d抽取患者空腹静脉血测定ChE水平。结果两组患者术后1、3、5、7 d血浆ChE水平均较术前降低，且POCD组较非POCD组降低更明显，差异有统计学意义（P〈0.05）；POCD组术前1 d血浆ChE水平明显低于非POCD组，差异有统计学意义（P=0.017）；血浆ChE水平与MMSE评分呈正相关（r=0.630，P〈0.01）。结论关节置换术患者血浆ChE水平降低与POCD的发生密切相关。

Relevant research on concentrations of plasma cholinesterase and POCD in patients with arthroplasty

Objective To discuss the influence of plasma cholinesterase （ChE） of patients with arthroplasty on postopera-tive cognitive dysfunction （POCD）. Methods Totally 85 patients with knee,hip arthroplasty were selected and divided into POCD group（n=32,39.02%） and non-POCD group（n=50,61.00%） according to occurrence of POCD. All patients were measured with mini-mental state examination（MMSE） on cognitive function on 1st d before surgery and 1st,3rd,5th,7th d after surgery, meanwhile,the ChE concentrations were also detected by drawing fasting venous blood. Results The ChE concentrations in both groups decreased on 1st,3rd,5th,7th d,and the POCD group decreased more significantly than the non-POCD group（P〈0.05）. The plasma concentration in the POCD group was promiently lower than that in non-POCD group on 1 d before surgery,the dif-ference was statistically significant（P=0.017）. The plasma ChE concentration and MMSE score were positively correlated（r=0.630, P〈0.01）. Conclusion Reduced plasma concentrations of ChE is closely associated with the incidence of POCD in patients with arthroplasty.