Gao Sunan, Dai Hongyu, Hao Qian, Song Jiale, Ji Kang, Xu Hongwei, Chen Gang, Lu Jian
Department of Anesthesiology, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China.
Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China.
J Transl Med. 2025 Jun 10;23(1):637. doi: 10.1186/s12967-025-06584-2.
Postoperative cognitive dysfunction (POCD) may last for days, months or even years, leading to prolonged hospitalization and increased costs, increased mortality, and poor quality of life. Although POCD is an important clinical problem, its prevention, treatment strategies and effects are still limited. Therefore, this study aims to investigate the preventive effect of perioperative probiotic intervention on POCD in elderly patients, and further explore the mechanism of probiotics in improving postoperative cognitive function.
After obtaining ethical approval and written informed consent, 190 patients aged 65 years or older scheduled for elective lower-extremity orthopedic surgery were enrolled in this randomized, single-center, double-blind trial. Enrolled patients were randomized to probiotic or control groups receiving either probiotics or placebo (210 mgx4/dose orally, 2 times/day) from 1 day before surgery to 5 days after surgery. The primary outcome was the cognitive function assessed by Mini-mental State Examination (MMSE) on admission, the first day, the third day and the seventh day after surgery. The secondary outcomes included perioperative changes in plasma IL-1β, IL-6 and BDNF, postoperative pain intensity, perioperative activities of daily living (ADL), faecal microbiota composition and changes of intestinal metabolites RESULTS: The incidence of POCD in the probiotic group was significantly lower than in the control group (6 of 90 patients [6.7%] vs. 16 of 93 patients [17.2%], P = 0.028). In addition, the plasma levels of proinflammatory cytokines IL-1β and IL-6 were significantly lower and BDNF levels were significantly higher in the probiotic group than in the control group 1-2 days after surgery (U = 173.0, P < 0.01; U = 139.0, P < 0.01; U = 207.0, P < 0.01).
Perioperative probiotic intervention can reduce the incidence of POCD in elderly patients, which may improve cognitive function by inhibiting inflammatory response after anesthesia and surgery, and altering the composition of the postoperative gut microbiota and intestinal metabolites.
术后认知功能障碍（POCD）可能持续数天、数月甚至数年，导致住院时间延长、费用增加、死亡率上升以及生活质量下降。尽管POCD是一个重要的临床问题，但其预防、治疗策略及效果仍然有限。因此，本研究旨在探讨围手术期益生菌干预对老年患者POCD的预防作用，并进一步探究益生菌改善术后认知功能的机制。
在获得伦理批准和书面知情同意后，190例年龄≥65岁、计划接受择期下肢骨科手术的患者被纳入这项随机、单中心、双盲试验。将入选患者随机分为益生菌组或对照组，从术前1天至术后5天，分别给予益生菌或安慰剂（210mg/剂量口服，每日2次）。主要结局指标为术前、术后第1天、第3天和第7天通过简易精神状态检查表（MMSE）评估的认知功能。次要结局指标包括围手术期血浆白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）和脑源性神经营养因子（BDNF）的变化、术后疼痛强度、围手术期日常生活活动能力（ADL）、粪便微生物群组成及肠道代谢产物的变化。结果：益生菌组POCD的发生率显著低于对照组（90例患者中有6例[6.7%]，而93例患者中有16例[17.2%]，P = 0.028）。此外，术后1 - 2天，益生菌组促炎细胞因子IL-1β和IL-6的血浆水平显著低于对照组，BDNF水平显著高于对照组（U = 173.0，P < 0.01；U = 139.0，P < 0.01；U = 207.0，P < 0.01）。
围手术期益生菌干预可降低老年患者POCD的发生率，这可能通过抑制麻醉和手术后的炎症反应、改变术后肠道微生物群组成及肠道代谢产物来改善认知功能。
