Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, No. 247 Renmin road, Ningbo City 315000, Zhejiang Province, China.
Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, No. 247 Renmin road, Ningbo City 315000, Zhejiang Province, China
Biosci Rep. 2019 Jun 20;39(6). doi: 10.1042/BSR20190166. Print 2019 Jun 28.
Postoperative cognitive dysfunction (POCD) is a great problem for anesthetized subjects and is associated with poor short- and long-term outcomes. We explored promising predictors for POCD in elderly patients after hip fracture surgery. Elderly subjects (aged ≥65 years) undergoing surgery for hip fracture were consecutively recruited. Neuropsychological assessments were performed 1 day preoperatively (baseline) and 7 days postoperatively, and POCD was defined using the ' scores' method. Clinical data and laboratory tests were compared between patients with and without POCD development. Binary univariate and multivariate logistic regression analyses were conducted for risk factor assessment. Receiver operating characteristic (ROC) curve analysis was performed to investigate the predictive value of malondialdehyde (MDA) on postoperative day 1 (POD1) for POCD. A total of 198 patients were finally enrolled in the analysis and 51 patients exhibited POCD within 7 postoperative days, with an incidence rate of 25.8%. MDA expression on POD1 (OR: 1.12, 95%CI: 1.03-1.23, =0.017) was the only independent risk factor for POCD according to the final multivariate logistic regression analysis. ROC curve analysis indicated that MDA on POD1 was a predictor for POCD, with an area under the curve (AUC) of 0.683 and 95%CI of 0.590-0.775 (<0.001). In conclusion, we demonstrated that MDA on POD1 was an independent risk factor for POCD in elderly subjects undergoing hip fracture surgery.
术后认知功能障碍（POCD）是麻醉患者的一个重大问题，与短期和长期预后不良有关。我们探讨了老年髋部骨折手术后 POCD 的有前途的预测因素。连续招募了接受髋部骨折手术的老年患者（年龄≥65 岁）。在术前 1 天（基线）和术后 7 天进行神经心理学评估，并使用“分数”方法定义 POCD。比较了有无 POCD 发展的患者的临床数据和实验室检查。进行了二项单变量和多变量逻辑回归分析，以评估危险因素。进行了接收者操作特征（ROC）曲线分析，以研究术后第 1 天（POD1）丙二醛（MDA）对 POCD 的预测价值。共有 198 例患者最终纳入分析，51 例患者在术后 7 天内出现 POCD，发生率为 25.8%。根据最终的多变量逻辑回归分析，POD1 时的 MDA 表达（OR：1.12，95%CI：1.03-1.23，=0.017）是 POCD 的唯一独立危险因素。ROC 曲线分析表明，POD1 时的 MDA 是 POCD 的预测指标，曲线下面积（AUC）为 0.683，95%CI 为 0.590-0.775（<0.001）。总之，我们证明了 POD1 时的 MDA 是老年髋部骨折手术患者 POCD 的独立危险因素。
