| Objective: In this study,we aimed to study the effect of the forced air-warming system or routine temperature protection measures on temperature change in elderly patients and the incidence of postoperative cognitive dysfunction(Post Operative Cognitive Dysfunction,POCD),and observe the relevance of serum Tau protein phosphorylation and POCD,so as to provide a reference for clinical anesthesia management of elderly people in order to improve the prognosis,and improve the quality of life after surgery.Methods: 60 cases of elderly patients undergoing major orthopedics surgery(joint replacement,openning spinal surgery)were brought into this study.All of them are over 65 years old.The anesthetic method was endotracheal intubation and inhalation combined general anesthesia.According to the odd or even number of their inpatient number,they were divided into the heat preservation group and conventional group(30 cases in each group).In the heat preservation group,3M Bair Hugger Model 750 warming system were used to giving the active insulation measure,by adjusting the temperature of the system,the temperature were maintained at 36 ~37?,At the same time,the conventional heat preservation measures,such as intravenous infusion of liquid heat preservation,environmental temperature control,blanket and towel covering,were also used.And the conventional group.The heating system of Model 750 were not given,and the above routine heat preservation measures were given only.The temperature of the nasopharynx was monitored by the MINDRAY MR401B thermosensitive temperature probe during the operation.And we also monitored the heart rate,blood pressure,Pulse Oxygen Saturation(SPO2)and end-tidal carbon dioxide(ETCO2)during the operation.Cerebral State Index(CSI)were maintained at 40~60 by regulating the dose of narcotic drugs.The observation target were: 1.The Mini-Mental State Examination(MMSE)were used to evaluate the cognitive function of the patients on preoperative 1D,postoperative 1D,postoperative 3D and postoperative 7D.2.The levels of serum phosphorylated tau protein(P-Tau),and A beta 1-42 amyloid protein were detected by peripheral venous blood 5ml and Enzyme-Linked Immuno Sorbent Assay(ELISA)on preoperative 1D,postoperative 1D,postoperative 3D and postoperative 7d.3.The complications of two groups were observed: such as massive hemorrhage,postoperative fever,arrhythmia,and pulmonary infection.Result:1.Comparing the general data of the two groups,the preoperative physical signs,the preoperative MMSE score,the average value of the heart rate,blood pressure,SPO2,ETCO2,CSI,the type of operation,the time of operation and the amount of bleeding of the operation,there was no statistical difference(P>0.05)between the two groups.While the body temperature in the heat preservation group was higher than that in the conventional group(P<0.05),and the incidence of complications in the heat preservation group was lower than that in the conventional group,the difference was statistically significant(P<0.05).statistically significant difference in serum P-Tau protein concentration between the two groups of patients 1D before operation(P>0.05).But on 1D,3D after operation,the patients in the heat preservation group were lower than the conventional group,and the difference was statistically significant(P<0.05).Intra group comparisons: on 1D,3D after operation,the level of P-Tau protein in each group was higher than 1D before operation,and the difference was statistically significant(P<0.05).And on 7d after the operation,in the heat preservation group,there was no significant difference comparing with the 1D before operation(P>0.05).While in the conventional group,the difference was statistically significant higher than that 1D before the operation(P<0.05).2.Tau protein comparisons: comparisons between groups: There was no3.Comparisons of A beta 1-42 protein: inter group comparisons: the serum A beta 1-42 protein concentration in the two groups was not statistically significant(P>0.05)1D before and 1D,3D,7D after the operation.Intra group comparison: 1D,3D,7D postoperative the conventional group was higher than preoperative,and the difference was statistically significant(P<0.05).In the heat preservation group,on 1D,3D after operation,the serum A beta 1-42 protein concentration was higher than that before the operation,and the difference was statistically significant(P<0.05).On 7d after operation,the concentration of the heat preservation group recovered to the preoperative level,and the difference was not statistically significant(P>0.05).The correlation test of MMSE score with P-Tau protein and A beta 1-42 protein: The correlation between the serum P-Tau protein,A beta 1-42 protein and the MMSE score at each time point was evaluated by Pearson correlation detection.Evaluation of correlation coefficient R shows very strong correlation for 0.8-1.0,and 0.6-0.8 show a strong correlation,0.4-0.6 shows a moderate degree of correlation,0.2-0.4 shows weak correlation,0.0-0.2 shows very weak correlation or no correlation.The final result shows: the correlation between P-Tau protein and MMSE: in heat preservation group,moderate degree were shown before operation,strong correlation on 1D and 3D after operation and moderate degree on 7d after operation,in the conventional group,before operation strong correlation were shown,on 1D 3D,7D after operation very strong correlation waer shown.Total correlation: the thermal insulation group is strong correlation,the conventional group is very strong correlation.A beta 1-42 protein: heat preservation group moderate degree were shown before operation,1D after operation was extremely weak,3D after operation was associated with moderate degree.7D after operation was weakly correlated.In the Routine group,Strong correlation before operation,1D after operation was extremely weak after operation,3D and 7D after operation were moderately related after operation.Total correlation: the two groups were all weakly related.Conclusion: Relative to conventional passive thermometer protection,the usage of 3M Bair Hugger Model 750 heating system for perioperative active thermometer protection can improve the patient's intraoperative temperature,and improve the postoperative cognitive function,reduction of postoperative cognitive impairment and the incidence of complications;In the process of large surgery for the elderly in the orthopedics,only conventional thermometer measures are inadequate.The temperature is relatively lower,this leads to the impairment of postoperative cognitive function and the incidence of POCD increased,The phosphorylation of Tau protein may play a role in impaired cognitive function,but the A beta protein pathway may not play a role in it. |
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