Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China.
J Anesth. 2013 Aug;27(4):487-92. doi: 10.1007/s00540-012-1548-6. Epub 2013 Jan 31.
Postoperative cognitive dysfunction (POCD) is a formidable public health issue, which would not only affect the quality of life among elderly patients but also lead to pulmonary infection and increased mortality. While, there is a lack of an effective indicator in predicting POCD. As one pivotal part of the limbic system in brain, hippocampus is associated with cognitive function. Hippocampal atrophy could indicate the degree of changes in cognitive function.
Forty-one ASA II or III patients (23 male, 18 female) aged ≥65 years undergoing open gastrointestinal tract surgery were enrolled in this study. MRI was performed to measure the volume of hippocampal formation before surgery and the results were standardized according to individual intracranial volume. All patients underwent a battery of neuropsychological tests including sensitive tests on the Wechsler adult memory scale and Wechsler adult intelligence scale, trail making test and the grooved pegboard test. We used the Z score to identify POCD as recommended by ISPOCD. All patients were then divided into POCD group and non-POCD group according to the results of the neuropsychological tests. The results of the tests were correlated with the volume of hippocampal formation measured by MRI. The value of MRI measurement of hippocampal volume in predicting POCD was analyzed. Multivariate linear correlation analyses of compositive Z score using potential contributing factors such as age, duration of anesthesia, education and hippocampal volume was carried out.
Thirty-six patients completed the whole battery of neuropsychological tests after surgery. Thirteen of the 36 patients were found to have POCD (36 %) on the postoperative 4th day. The hippocampal volume was significantly smaller in POCD group (4.75 ± 0.23) than in non-POCD group (5.06 ± 0.31). Hippocampal volume had great influence on Z score, and had negative correlation with Z score.
The MRI measurement of hippocampal volume is suggested to be valuable as a predictor of POCD in the elderly.
术后认知功能障碍（POCD）是一个严重的公共卫生问题，它不仅会影响老年患者的生活质量，还会导致肺部感染和死亡率增加。然而，目前缺乏预测 POCD 的有效指标。海马作为大脑边缘系统的重要组成部分，与认知功能密切相关。海马萎缩可以反映认知功能变化的程度。
本研究纳入 41 例年龄≥65 岁、ASA Ⅱ或Ⅲ级拟行胃肠道开放手术的患者。所有患者术前均行 MRI 检查，测量海马结构体积，并根据个体颅内体积进行标准化。所有患者均行神经心理学测试，包括韦氏成人记忆量表和韦氏成人智力量表的敏感测试、连线测试和槽型钉板测试。我们采用 ISPOCD 推荐的 Z 评分来识别 POCD。根据神经心理学测试结果将所有患者分为 POCD 组和非 POCD 组。分析 MRI 测量的海马体积与测试结果的相关性。采用多元线性相关分析，以年龄、麻醉时间、教育程度和海马体积等潜在影响因素为自变量，对综合 Z 评分进行分析。
术后 36 例患者完成了整个神经心理学测试。术后第 4 天，36 例患者中有 13 例（36%）发生 POCD。POCD 组的海马体积（4.75±0.23）明显小于非 POCD 组（5.06±0.31）。海马体积对 Z 评分影响较大，与 Z 评分呈负相关。
MRI 测量的海马体积可能是预测老年人 POCD 的有用指标。
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