体力活动与膝或髋关节置换术老年患者术后谵妄的关系
Relationship between physical activity and postoperative delirium in elderly patients undergoing knee or hip arthroplasty
孔荐 1邱云飞 2徐钐凌 1王元龙 3化树慧 3林亚男 4李传 4董瑞 4巩红岩 4林旭 4王彬 4毕燕琳4
作者信息
- 1. 山东第二医科大学麻醉学院,潍坊 261053
- 2. 青岛市第八人民医院麻醉科,青岛 266071
- 3. 滨州医学院第二临床医学院,烟台 264003
- 4. 青岛市市立医院麻醉科,青岛 266071
- 折叠
摘要
目的 评价体力活动(PA)与膝或髋关节置换术老年患者术后谵妄(POD)的关系.方法 基于围术期神经认知障碍和生物标志物生活方式队列,属于巢式病例对照研究.收集2022年8月至2023年8月在青岛市市立医院于脊椎-硬膜外麻醉下行择期膝或髋关节置换术老年患者病历资料,依据是否发生POD将其分为POD组(n=89)和非POD组(n=221).术前抽取外周血标本,脊椎-硬膜外麻醉穿刺成功后抽取脑脊液(CSF)2 ml,采用ELISA法测定β淀粉样蛋白42(Aβ42)、总tau蛋白(t-tau)及磷酸化tau蛋白(p-tau)浓度.logistics回归法筛选POD的影响因素,进行CSF生物标志物的中介效应分析.结果 logistic回归校正高血压、糖尿病、饮酒史、受教育年限和MMSE评分等多项混杂因素后,结果显示,CSF Aβ42浓度升高(OR=0.997,P=0.006)、Aβ42/t-tau比值升高(OR=0.642,P=0.003)、Aβ42/p-tau 比值升高(OR=0.872,P=0.001)和 PA(OR=0.374,P=0.001)为老年患者 POD 的保护因素,t-tau 浓度升高(OR=1.006,P=0.001)和 p-tau 浓度升高(OR=1.030,P=0.011)是膝或髋关节置换术老年患者POD的危险因素.中介效应显示,PA与老年患者POD的关系由Aβ42浓度(20％)、t-tau 浓度(16％)、Aβ42/t-tau 比值(23％)和 Aβ42/p-tau 比值(28％)介导.结论 PA是膝或髋关节置换术老年患者POD的保护因素,其可能通过CSF生物标志物发挥中介效应预防POD发生.
Abstract
Objective To evaluate the relationship between physical activity(PA)and postopera-tive delirium(POD)in elderly patients undergoing knee or hip arthroplasty.Methods The study was con-ducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort,which was a nested case-control study.Medical records from elderly patients undergoing elective knee or hip arthroplasty under spinal-epidural anesthesia at Qingdao Municipal Hospital from August 2022 to August 2023 were col-lected.The patients were divided into a POD group(n=89)and a non-POD group(n=221)based on the occurrence of POD.Peripheral blood samples were collected before surgery,and the cerebrospinal fluid(CSF)2 ml was extracted after successful puncture under spinal-epidural anesthesia for determination of the concentrations of amyloid-β 42(Aβ42),total tau protein(t-tau),and phosphorylated tau protein(p-tau)by enzyme-linked immunosorbent assay.Logistic regression was used to analyze the influencing factors of POD,and the mediation analysis was conducted to examine the mediating role of CSF biomarker in the rela-tionship between PA and POD.Results Logistic regression analysis showed that the increased concentra-tion of CSF biomarkers Aβ42(OR=0.997,P=0.006),elevated ratio of Aβ42/t-tau(OR=0.642,P=0.003),elevated ratio of Aβ42/p-tau ratio(OR=0.872,P=0.001)and PA(OR=0.374,P=0.001)were protective factors for POD,while the elevated concentrations of t-tau(OR=1.006,P=0.001)and p-tau(OR=1.030,P=0.011)were risk factors for POD after adjusting for multi-confounders such as hyperten-sion,diabetes,history of drinking,years of education and Mini-Mental State Examination score.The results of the mediation analysis showed that Aβ42(20％),t-tau(16％),Aβ42/t-tau(23％)and Aβ42/p-tau(28％)played mediating roles in the relationship between PA and POD.Conclusions PA is a protective factor for POD in elderly patients undergoing knee or hip arthroplasty and CSF biomarkers may play a media-ting role in the relationship between PA and POD.
关键词
体力活动/关节成形术,置换3膝/关节成形术,置换,髋/老年人/谵妄Key words
Physical exertion/Arthroplasty,replacement,knee/Arthroplasty,replacement,hip/Postoperative complications/Aged/Delirious speech引用本文复制引用
出版年
2024
NETL
NSTL
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