β淀粉样蛋白1-40与老年患者颌面外科手术后并发谵妄的关系

目的观察老年颌面外科手术患者全身麻醉后术后谵妄（PD）的患病率,研究血浆β淀粉样蛋白1-40（Aβ1-40）与PD的关系。方法选择50例颌面外科手术患者,按照年龄分为T组（30例,年龄62~78岁）和C组（20例,年龄20~60岁）,2组均采用静吸复合麻醉,以谵妄评定量表1998年修订版（DRS-R-98）来诊断和评估PD发生状况,记录术前（T0）,术后24 h（T1）、48 h（T2）、72 h（T3）、96 h（T4）的DRS-R-98评分;并测定Aβ1-40质量浓度。结果T组患者PD的患病率为20.0%。T组Aβ1-40质量浓度在T0、T1、T2、T3时段明显高于C组（P＜0.01）,T组和C组Aβ1-40质量浓度在T1和T2时段明显高于同组T0时段（P＜0.05）。T组在T3和T4时段的DRS-R-98评分明显高于同组T1时段和C组（P＜0.01）。结论Aβ1-40在全身麻醉后持续升高可能是老年患者发生PD的重要原因之一。

Relationship between beta amyloid protein 1-40 and post-operative delirium after oral and maxillofacial surgery in elderly patients

Objective To determine the incidence of post-operative delirium after oral and maxillofacial surgery under general anesthesia in elderly patients, and to examine its association with plasma concentrations of beta amyloid protein 1-40（Aβ1-40）. Methods Fifty patients underwent elective oral and maxillofacial surgery were divided into two groups: Group C（n=20） aged from 20 to 60 years old, and Group T（n=30） aged from 62 to 78 years old. The two group received the same general anesthesia. Delirium rating scale-revised-98（DRS-R-98） was used as an instrument to diagnose and access the postoperative delirium of the two groups. The scores of DRS-R-98 were recorded before operation（T0） and at 24 h（T1）, 48 h（T2）, 72 h（T3） and 96 h（T4） after the operation. Serial measurements of serum concentrations of Aβ1-40 were also performed at the same time. Results The incidence of post -operative delirium after oral and maxillofacial surgery in Group T was 20.0%. The concentrations of plasma Aβ1-40 in group T were much higher than group C at T0, T1, T2 and T3 significantly（P＜0.01）. The concentrations of plasma Aβ1-40 at T1 and T2 were higher than those at T0 in the same group（P＜0.05）. The scores of DRS-R-98 in Group T at T3 and T4 were much higher than those at T1 and Group C significantly（P＜0.01）. Conclusion The constant increase of plasma Aβ1-40 may be one of the important factors related to post-operative delirium in elderly patients underwent oral and maxillofacial surgery.