Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Hepatobiliary Pancreat Dis Int. 2013 Aug;12(4):370-6. doi: 10.1016/s1499-3872(13)60058-2.
Postoperative cognitive dysfunction (POCD) is an adverse condition characterized by declined cognitive functions following surgeries and anesthesia. POCD has been associated with increased hospital stay and mortality. There are histological similarities to Alzheimer's disease. Most early studies were conducted in patients receiving cardiac surgery. Since there is no information about POCD in liver transplant recipients, we measured the incidence of POCD in patients after liver transplantation and examined the correlation between neurological dysfunction and biological markers of dementia-based diseases.
We studied 25 patients who had a liver transplan-tation between July 2008 and February 2009. Patients with prior encephalopathy or risk factors associated with the development of POCD were excluded from the study. Five validated neuropsychiatric tests were used for diagnosis. The diagnosis was based on one standard deviation decline in two of the five neuropsychiatric tests. The correlation between patient variables and the development of POCD was examined. Serum levels of beta-amyloid and C-reactive protein were measured by standard ELISA and compared between patients with and without POCD.
POCD was present in 11 (44%) of the 25 patients. Patients with POCD had significantly higher MELD scores, were more often Child-Pugh class C and received more blood transfusion during surgery. The serum beta-amyloid protein and C-reactive protein concentrations were significantly increased at 24 hours after surgery in the POCD group.
The incidence of POCD in our group of liver transplant patients was greater than that reported in other surgical patients. The increase in the serum biomarkers of dementia in the POCD patients supports the hypothesis that chronic cognitive defects are due to a process similar to that seen in Alzheimer's disease.
术后认知功能障碍（POCD）是一种不良状况，表现为手术后和麻醉后认知功能下降。POCD 与住院时间延长和死亡率增加有关。其组织学与阿尔茨海默病相似。大多数早期研究是在接受心脏手术的患者中进行的。由于尚无肝移植受者 POCD 的信息，我们测量了肝移植后患者 POCD 的发生率，并检查了神经功能障碍与痴呆相关疾病的生物标志物之间的相关性。
我们研究了 2008 年 7 月至 2009 年 2 月期间进行肝移植的 25 名患者。排除有脑病或与 POCD 发展相关的危险因素的患者。使用 5 种经过验证的神经精神病学测试进行诊断。诊断基于 5 种神经精神病学测试中的两种有一项标准偏差下降。检查了患者变量与 POCD 发展之间的相关性。通过标准 ELISA 测量血清中β-淀粉样蛋白和 C-反应蛋白的水平，并比较 POCD 患者与无 POCD 患者之间的差异。
25 名患者中有 11 名（44％）存在 POCD。患有 POCD 的患者 MELD 评分显著更高，Child-Pugh 分级更常为 C 级，并且在手术中接受了更多的输血。POCD 组患者术后 24 小时血清β-淀粉样蛋白和 C-反应蛋白浓度显著升高。
我们组肝移植患者的 POCD 发生率高于其他外科手术患者。POCD 患者血清痴呆生物标志物的增加支持了这样一种假设，即慢性认知缺陷是由于类似于阿尔茨海默病所见的过程所致。
