發(fā)布時間：2018-04-11 22:33

  本文選題：頸動脈斑塊 + 術后譫妄(POD)�。� 參考：《山東大學》2017年碩士論文

【摘要】：[背景目的]術后譫妄(postoperative delirium,POD)指術后出現(xiàn)的意識、感知力、注意力、思維、記憶及睡眠周期等方面的紊亂綜合征,是一種病原學非特異的腦綜合征,術后48-72h為發(fā)生高峰期,可逆性和波動性為其特點。老齡被認為是POD的獨立危險因素。脂蛋白相關磷脂酶A2(LP-PLA2)來源于巨噬細胞、肥大細胞等炎癥細胞,具有氧化應激、炎癥反應作用,且與動脈粥樣斑塊的發(fā)生與破潰過程有關。本研究旨在探索頸動脈粥樣硬化斑塊(Carotid atherosclerotic plaque)穩(wěn)定性及圍術期血清LP-PLA2水平與老年患者的髖關節(jié)置換術后譫妄的關系。[研究方法]本課題選取2016年7月至2017年1月在山東大學齊魯醫(yī)院(青島)于腰硬聯(lián)合麻醉聯(lián)合髂筋膜神經(jīng)阻滯下行髖關節(jié)置換術的老年患者62例,記錄患者一般情況如年齡、性別、病史(高血壓、糖尿病、冠心病、心房纖顫、吸煙飲酒史、教育程度)、心電圖、是否處于他汀類藥物治療中等,記錄術前實驗室化驗結果(中性粒細胞計數(shù)、總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿素氮)。術前以超聲檢查評估患者頸動脈是否存在斑塊及并依據(jù)頸動脈狹窄程度進行分級。術后以意識錯亂評估法(CAM)診斷POD,收集患者圍術期(術前、術畢、術后第2天)血液標本,并以ELISA法檢測血清中LP-PLA2水平。分組:根據(jù)是否存在頸動脈粥樣斑塊將入選研究對象分為斑塊組與非斑塊組,根據(jù)是否發(fā)生POD將斑塊組分為譫妄亞組(POD亞組)與非譫妄亞組(非POD亞組)。[結果分析]1.斑塊組與非斑塊組患者一般資料比較兩組患者術前一般資料(年齡、性別、術前合并癥、是否處于他汀類藥物治療中、吸煙飲酒史、教育程度),術前實驗室化驗(中性粒細胞計數(shù)、總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿素氮)分別比較,差異無統(tǒng)計學意義(P0.05)。2.手術相關指標、術后RASS評分及VAS評分比較斑塊組與非斑塊組手術持續(xù)時間、術中失血量、術中補液量、是否應用骨水泥等分別比較,差異無統(tǒng)計學意義,兩組術后VAS評分及RASS評分差異無統(tǒng)計學意義(P0.05)。3.斑塊組與非斑塊組術后譫妄發(fā)生情況比較斑塊組POD發(fā)病率為38.9%;非斑塊組患者POD發(fā)病率為7.69%,兩組POD發(fā)病率差異具有統(tǒng)計學意義(P0.05)。4.血清LP-PLA2水平斑塊組與非斑塊組相比,術前、術畢、術后第2天血清LP-PLA2水平差異均無統(tǒng)計學意義(P0.05)。斑塊組中,譫妄亞組較非譫妄亞組,術前、術畢血清LP-PLA2水平差異均無統(tǒng)計學意義(P0.05),譫妄亞組術后第2天血清LP-PLA2水平較非譫妄亞組高(P0.05)。[實驗結論]實驗得出,斑塊組POD發(fā)病率明顯高于非斑塊組,老年患者頸動脈斑塊與術后譫妄的發(fā)生相關。斑塊組中,譫妄亞組較非譫妄亞組,術后第2天LP-PLA2水平高,提示頸動脈斑塊穩(wěn)定性下降可影響POD的發(fā)生。
[Abstract]:[background] postoperative delirium delirium POD (POD) refers to the disorder syndrome of consciousness, perception, attention, thinking, memory and sleep cycle.Reversibility and volatility are its characteristics.Ageing is considered an independent risk factor for POD.Lipoprotein associated phospholipase A2 (LP-PLA2), derived from macrophages, mast cells and other inflammatory cells, has oxidative stress and inflammatory response, and is related to the occurrence of atherosclerotic plaques and the process of breaking down.The purpose of this study was to investigate the relationship between the stability of carotid atherosclerotic plaque Carotid atherosclerotic plaqueand the perioperative serum LP-PLA2 level and delirium after hip arthroplasty in elderly patients.[methods] from July 2016 to January 2017, 62 elderly patients undergoing hip arthroplasty under combined spinal-epidural anesthesia and iliac fascial nerve block in Qilu Hospital of Shandong University (Qingdao) were selected, and the general conditions of the patients were recorded, such as age.Sex, history (hypertension, diabetes, coronary heart disease, atrial fibrillation, smoking and drinking history, education level, electrocardiogram, whether in statins treatment medium, record preoperative laboratory results (neutrophil count, total cholesterol),Triglyceride, low density lipoprotein, high density lipoprotein, urea nitrogen.Preoperative ultrasonography was used to evaluate the carotid artery plaque and grade according to the degree of carotid artery stenosis.Postoperatively, the patients were diagnosed by the method of consciousness disorder assessment. The blood samples were collected during the perioperative period (preoperative, postoperative, and the second day after operation), and the serum LP-PLA2 levels were measured by ELISA method.Group: according to the presence of carotid atherosclerotic plaque, the subjects were divided into plaque group and non-plaque group, plaque subgroup was divided into delirium subgroup (POD subgroup) and non-delirium subgroup (non-delirium subgroup) according to the occurrence of POD.[result analysis] 1.The general data of patients in plaque group and non-plaque group were compared before operation (age, sex, complications before operation, whether in statins or not, smoking and drinking history).Educational level and laboratory test (neutrophil count, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, urea nitrogen) showed no significant difference (P 0.05).Comparison of operative duration, intraoperative blood loss, intraoperative fluid rehydration and bone cement use in plaque group and non-plaque group, there was no significant difference between the two groups.There was no significant difference in VAS score and RASS score between the two groups (P 0.05. 3).Comparison of postoperative delirium incidence between plaque group and non-plaque group the incidence of POD in plaque group was 38.9 and that in non-plaque group was 7.69.The difference of POD incidence between the two groups was statistically significant (P 0.05).There was no significant difference in serum LP-PLA2 levels between plaque group and non-plaque group before operation, at the end of operation and on the second day after operation. There was no significant difference in serum LP-PLA2 level between plaque group and non-plaque group (P 0.05).In the plaque group, the serum LP-PLA2 level in the delirium subgroup was significantly higher than that in the non-delirium subgroup before and after operation (P 0.05), and the level of serum LP-PLA2 in the delirium subgroup was higher than that in the non-delirium subgroup on the second day after operation (P 0.05).[conclusion] the incidence of POD in plaque group was significantly higher than that in non-plaque group. Carotid plaque was associated with postoperative delirium in elderly patients.In plaque group, delirium subgroup was higher than non-delirium subgroup, and LP-PLA2 level was higher on the second day after operation, suggesting that the decrease of carotid plaque stability might affect the occurrence of POD.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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相關期刊論文 前1條

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本文編號：1737947