| Objective:To investigate different anesthesia methods on the occurrence of early postoperative cognitive dysfunction (POCD) in elderly hip arthroplasty patients, to provide the clinical basis for the selection of anesthesia in elderly hip arthroplasty, and to observe the influence of different anesthesia on early stage POCD in elderly patients with hip replacement surgery. Meanwhile, to explore the relation between POCD and Aβand Tau protein, to discover the possible pathogenesis of POCD.Methods:One hundrend elderly patients with hip replacement surgery:50 cases is general anesthesia group (group G) and another 50 cases is the epidural group (group E).The Mini Mental Exam (MMSE) Form was respectively used in marking for patients at first day before surgery (T1), first day after surgery(T2),5th day after surgery(T3). Cognitive dysfunction was occurred when MMSE score decreased 1 standard deviation comparing with preoperative score. Peripheral venous bloods were extracted on the T1 and T2, T3 timepoint before breakfast, enzyme-linked immunosorbent assay (ELISA) was used to detect Aβand Tau protein concentration in the serum. Based on whether have POCD in the first day after surgery, patients were divided into non-POCD group(group NP) and POCD group(group P), and serum A(3 and Tau protein levels were compared between group P and group NP. Results:1.MMSE score:compared with group E, the first day before surgery and the 5th day after surgery have no statistically significance (P>0.05) in group G.the score decreased significantly in the first day after surgery, the difference was significant (P<0.05). Intragroup comparison:In group G, compared with the first day before surgery, MMSE score was significantly lower in first day after surgery (P＜0.05). in the 5th day after surgery there was no statistical difference (P>0.05). in group E, there were no significantly change at different time points (P>0.05).2.The incidence rate of POCD:The first day after surgery,18 patients have POCD in group G (36%), and 8 patients have POCD in group E (16%).group G was significantly higher than group E (P<0.05).in the 5th day after surgery there was no statistical difference (P>0.05).3. Comparison of Aβand Tau protein between group G and group E:compared with group E, at T2 timepoint,the serum levels of group G were significantly increased (P<0.05). there were no significantly difference at T3 and T1 timepoint (P>0.05). Intragroup comparison:in group E, there were no significantly change at different time points (P>0.05), in group G:compared with T1:at T2 timepoint,the serum levels of Aβand Tau protein were significantly increased (P＜0.05), there were no significantly difference at T3 timepoint (P>0.05), moreover, there were significantly difference between T2 and T3 timepoints (P<0.05).4.Comparison of Aβand Tau protein between group P and group NP:compared with group NP, the serum level of group P was significantly higher than group NP (P<0.01) at T2 timepoint. there were no significantly difference at T3 and T1 timepoint (P>0.05). Different timepoints intragroup comparison: in group P, compared with T1, T2 timepoint was significantly higher (P＜0.01), there was not statistically significance at T3 timepoint, and T2 was significantly higher than to T3 timepoints (P<0.01). There was no significant difference at each timepoint (P>0.05) in group NP. Conclusion:1.POCD were occured in both groups in elderly patients with hip replacement surgery, but the incidence rate of POCD was higher in general anesthesia group than the epidural group in the first day after surgery.2.In general anesthesia group, the serum levels of Aβand Tau protein was significantly higher than the epidural anesthesia group. Whether it is the causes of different incidence of POCD need a further exploratin in the future.3.The serum level of Aβand Tau protein were significantly higher in POCD group than non-POCD group in the first day after surgery, speculated that the increase of Aβand Tau protein, may be one of mechanism for POCD occurrence.4.From the perspective of reducing POCD in elderly patients with hip replacement surgery, epidural anesthesia is better than general anesthesia. |
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