Clinical Relevance Analysis Between Postoperative Cognition Dysfunctin And Diabetes In Elderly Joint Repalcement Patients

Background of studyPostoperative cognitive dysfunction(POCD)is a clinical phenomenon after anesthesia and surgery and it is often occurred in elder surgical patients.POCD involves pre-to postoperative reduction in memory,mental flexibility,and information processing.POCD occurs just after anesthesia and surgery in the first few weeks.The reported incidence of POCD is 8.9%-46.1%.POCD increases periopertive complication,longer hospital stay and becomes a burden for family and society.It is also associated with increased mortality 1 year after surgery.POCD occurs after cardiac surgery and non-cardiac surgeiy Joint replacement surgery is one of the most of conducted non-cardiac surgery in older patients.Joint replacement needed to cut more organization intra-operative,and needed more time to accomplish the operation and often induced big trauma response.The report anesthesia for joint replacement surgery 1s general anesthesia.In joint replacement surgery,POCD occurred frequently.The incidence of POCD in total knee affhroplasty(TKR)is 19.4%--72%.And after six months,the incidence of POCD still keep 6.5%--29.5%.Patients received joint replacement surgery is older,and they often have one or two complication before surgery.Type 2 diabetes mellitus is one of the most common complication.Type 2 diabetes mellitus associated heart,kidney,and cerebrovascular complication is more than general patients,those lead to increase the risk for surgery.Moreover,Type 2 diabetes mellitus associated perioperative neurological complications increase,and Type 2 diabetes patients suffer surgery and anesthesia with high incidence of POCD.Currently,the mechanism of connection between POCD and Type 2 diabetes mellitus is unclear.Literature reports Type 2 diabetes mellitus induce cognition impairment and accelerate cognition impairment to dementia.In this study,we will observe 60 years or older patients receive joint replacement surgery,and analysis the incidence of POCD in this crowd.Next,we will explore the relationship between Diabetes,perioperative inflammation and Postoperative Cognitive Dysfunction in elderly patients undergoing joint replacement surgery.This will help us to identify the risk factor before the surgery.Objective1.To find explicit incidence of 60 years or older patients POCD after receiving joint replacement surgery,and we will identify the risk factor associated POCD.2.To explore the relationship between POCD and Type 2 diabetes,and speculate the under mechanism between them.3.To analysis the relationship between perioperative inflarmation and POCD.MethodsThis study was approved by the ethics comnittee of hospital and abtained informed consent of all patients.102 cases were collected in our hospital undergoing joint replacement surgery from March 2016 to April 2017.According to whether combined with type 2 diabetes,they were divided as type 2 diabetes group and control group.In control group,there were 14 males and 42 femals.In type 2 diabetes group,there were 11 males and 35 femals.the span of age was 60 to 86 years old,ASA class ItoⅢ.They were received five groups of neuro-psychological tests 1 day pre-operatively and on postopertive day 7 respectively,the following tests:Mini-mental state examination(MMSE);Stroop color-word test(SCWT);trail making test(part A,B);digital span-test;digital symbol substitution test(DSST).Results1.The incidence of POCD in joint replacement surgery1)Self contrast method:102 cases received joint replacement,a total 54 patients suffer POCD after anesthesia and surgery.The incidence of POCD is 52.94%.2)1 standard deviation method:102 cases received joint replacement,a total 20 patients suffer POCD after anesthesia and surgery.The incidence of POCD is 19.61%.2.Compared to control group,type 2 diabetes group has higher incidence of POCD.3.The long duration of type 2 diabetes is an independent risk factor in our study(OR=1.193,95%Cl 1.061 to 1.061,P=0.03).4.Analysis patiens underwent joint replacement perioperative blood glucosePerioperative blood glucose increased after undergoing joint replacement.Perioperative blood glucose of POCD group is always higher than non-POCD group.5.60 years or older received joint replacement,24 hours after surgery,the serum CRP、ESR、WBC and Neutrophilic granulocyte percentage is higher.In non-POCD group,CRP before surgery is higher.But in POCD group,serum levels of inflammatory cytokines changes more obvious.ConclusionPatients receiving joint replacement surgery is old and often combined type 2 diabetes.These patients had higher risk of POCD.Long duration of type 2 diabetes is one of the risk factor for POCD.In order to reduce the occurrence of POCD,we should intervene orthopedic patients before the surgery.