在接受全关节/膝关节置换的患者中,白天功能障碍可能与术后妄想有关:PNDABLE研究
Xu Lin1, Ming-Jing Pan2, Xiao-Yue Wu3
1Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China.
Brain and behavior
|October 5, 2023
概括
手术前的白天功能障碍是关节置换手术后手术后 Delirium (POD) 的危险因素. 大脑脊髓液P-tau蛋白可能部分调解这种关系,突出显示睡眠质量.
科学领域:
- 神经科学是一个神经科学.
- 老年学是一门学科.
- 整形外科手术 整形外科手术
背景情况:
- 手术后妄 (POD) 是主要的骨科手术后的常见并发症,如关节或膝盖置换.
- 术前睡眠障碍越来越多地被认为是术后认知功能障碍的潜在因素.
- 自我报告的睡眠特征作为POD预测者的特定作用仍然未得到充分研究.
研究的目的:
- 调查手术前自我报告的睡眠特征与手术后狂妄症 (POD) 发生率在接受全关节或膝关节置换的患者之间的关联.
- 确定特定的睡眠参数,这些参数可能是POD的风险因素.
- 探索大脑脊髓液 (CSF) 生物标志物在睡眠和POD之间的关系中的潜在调解作用.
主要方法:
- 一组495名经历关节/膝关节置换的认知完整患者在手术前使用匹兹堡睡眠质量指数 (PSQI) 评估睡眠质量和迷你精神状态检查认知状态.
- 术后痴呆症使用混乱评估方法和纪念痴呆症评估尺度进行评估.
- 在手术前测量了T-tau,P-tau,Aβ40和Aβ42的CSF水平. 统计分析包括逻辑回归,多重线性回归和调解分析.
主要成果:
- POD的发生率为11.31% (56/495名患者).
- 术前白天功能障碍,脑液P-tau和T-tau升高被确定为POD的显著风险因素,而Aβ42显示有保护作用.
- 在POD患者中,白天功能障碍与P-tau正相关,调解分析表明P-tau部分调解白天功能障碍对POD的影响.
结论:
- 手术前的白天功能障碍是患上术后妄想症的重要危险因素.
- 大脑脊髓液P-tau蛋白可能在将白天功能障碍与POD联系的途径中发挥部分调解作用.
- 针对手术前的睡眠质量,特别是白天的功能,可能是减轻POD风险的策略.
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