Relationship between preoperative mild cognitive impairment and postoperative delirium in patients undergoing total knee/hip arthroplasty
10.3760/cma.j.cn131073.20220509.01004
- VernacularTitle:全膝髋关节置换术患者术前轻度认知障碍与术后谵妄的关系
- Author:
Bin WANG
1
;
Shanshan WANG
;
Xinhui TANG
;
Fei WANG
;
Jiahan WANG
;
Xu LIN
;
Yanlin BI
Author Information
1. 青岛大学附属青岛市市立医院麻醉科，青岛 266071
- Keywords:
Cognitive dysfunction;
Delirium;
Postoperative complications
- From:
Chinese Journal of Anesthesiology
2022;42(10):1173-1177
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the relationship between preoperative mild cognitive impairment (MCI) and postoperative delirium (POD) in the patients undergoing total knee/hip arthroplasty.Methods:A total of 625 patients, aged 50-90 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing total knee and hip arthroplasty under combined spinal-epidural anesthesia from September 2021 to February 2022, were included.One day before surgery, the cognitive function was assessed using the Mini-Mental State Examination and the Montreal Cognitive Assessment scale.The patients were divided into non-MCI group (NMCI group) and MCI group according to the diagnostic criteria of MCI.The concentrations of amyloid beta 40 (Aβ40), amyloid beta 42 (Aβ42), total tau protein (T-tau) and phosphorylated tau protein (P-tau) in cerebrospinal fluid (CSF) were detected by enzyme-linked immunosorbent assay.The development of POD was assessed on 1-7 days after operation.The relationship between MCI and POD and relationship of concentrations of β40, Aβ42, T-tau and P-tau in CSFA, Aβ40/T-tau ratio, Aβ42/P-tau ratio and Aβ42/T-tau ratio with POD and MCI were analyzed using binary logistic regression.Results:Compared with NMCI group, the incidence of POD was significantly increased, the concentrations of Aβ42 and Aβ40 in CSF, Aβ40/T-tau ratio, Aβ42/P-tau ratio and Aβ42/T-tau ratio were decreased, and T-tau and P-tau concentrations in CSF were increased in MCI group ( P<0.05).The results of logistic regression analysis showed that before and after adjusting for confounding factors, increased MCI and concentrations of P-tau and T-tau in CSF were the risk factors for POD, and increased concentrations of Aβ42 and Aβ40 in CSF, Aβ40/T-tau ratio, Aβ42/P-tau ratio and Aβ42/T-tau ratio were protective factors for POD ( P<0.05); elevated concentrations of P-tau and T-tau in CSF were risk factors for MCI before and after adjusting for confounding factors, and increased concentrations of Aβ4 in CSF, Aβ40/T-tau ratio, Aβ42/P-tau ratio, and Aβ42/T-tau ratio were protective factors for MCI after adjusting for confounding factors ( P<0.05). Conclusions:Preoperative MCI are risk factors for POD in the patients undergoing total knee/hip arthroplasty.
