Short-term Exercise Reduced The Incidence Of Postoperative Cognitive Dysfuction(POCD) And Inflammatory Cytokines In Elderly Patients

Background:Postoperative cognitive dysfunction (POCD) is increasingly being recognised as a complication of surgery, especially in the elderly. One third of the elder patients surfer from POCD after total hip-replacement surgery. Although POCD is very common, there is still no generally accepted treatment or prevention methods at present. Therefore the aim of our study was to investigate whether the intelligent and rehabilitation exercises can reduce the incidence of POCD. And we sought to determine the relationship between cognitive decline and inflammation, namely Tumor necrosis factor-α (TNF-α) and high mobility group box-1(HMGB-1)Method:A prospective randomized double-blind clinical study, patients and investigators were blinded to the study design. Forty-four ASA Ⅱ-Ⅲ patients age≥60years undergoing unilateral total hip-replacement surgery were enrolled in this study. The patients were randomly divided into control and intervention group including23patients in each group. For the patients in the intervention group, they were received intelligent exercise on the1-2th day before surgery and3-7th after surgery, and joint with rehabilitation exercises on the3-7th after surgery. The patients in the control group would not receive any instruction and training during the hospital. All patients underwent a battery of neuropsychological tests before the surgery (On the1st day of the admission) and1week after surgery. The plasma levels of TNF-α and HMGB-1were measured by enzyme linked immunosorbent assay at T1(on the1st day of the mission) and T2(on the eighth day after surgery). A postoperative deficit in any test was defined as cognitive decline by more than or equal to the preoperative standard deviation of that test in all patients. POCD was defined if the patient showed cognitive decline in two or more tests. All statistical data were analyzed using STATA12.0.Results:1. In control group, the incidence of POCD was60.9%(14 cases); In intervention group, it was26.1%(6cases). The incidence of POCD in the intervention group was significantly lower than the control group (P<0.05).2. verbal memory test, delayed verbal memory test and word interference test appear the deterioration rate of postoperative function higher than the control group in POCD patients (P<0.05).3. The concentration of TNF-a and HMGB-1in intervention group were lower than that in control goup after surgery (P<0.05).Conclusion:Elderly patients after total hip-replacement surgery have higher incidence of POCD, and the method of intelligent exercise joint with rehabilitation exercises can effectively reduce the early postoperative incidence of POCD in elderly patients who received unilateral total hip-replacement surgery. The induced changes of POCD may focus on the memory of language. Perioperative exercise maybe improving cognitive fuction by reduced the levels of inflammation cytokines.