Association Of Hypertension With POCD In Elderly Patients With Joint Replacement

Background:Postoperative cognitive dysfunction(POCD)is a neurological complication after anesthesia and surgery,manifested as a short period of cognitive decline.POCD mainly affects the patient’s memory,attention,understanding[1],and can reduce Postoperative one-year survival rate.Age is the most important risk factor for POCD.It is generally accepted that the incidence of POCD in cardiac surgery and orthopedic surgery is relatively high.In addition,alcoholism,educational level,surgical trauma size,anesthesia time,operation frequency and postoperative infection can also affect the incidence of POCD.The pathogenesis of POCD is unclear.The current accepted view is that the inflammatory response is the main cause of POCD.POCD is more common in the elderly,and hypertension is one of the common chronic diseases in the elderly.Last year,the American Heart Association issued a statement that hypertension can adversely affect cognitive function,while hypertension can directly or indirectly lead to brain mcro Circulatory ischemia or inflammation.In addition,there are also studies announced hypertension is a low-grade inflammatory disease.Soluble vascular cell adhesion molecule-1(sVCAM-1)is a mature marker of endothelial injury associated with inflammation.It has the function of promoting the adhesion of circulating white blood cells.It is generally believed that it is associated with hypertension and arteries Atherosclerosis-related,there have been many reports that in a variety of disease conditions,such as coronary artery and peripheral atherosclerosis,hypertension,diabetes,plasma sVCAM-1 levels were significantly increased.sVCAM-1 plays an important role in accelerating atherosclerosis by promoting the attachment of inflammatory cells to the vascular wall and promoting subsequent endothelial migration.The resulting inflammation of the vessel wall,damage and stiffness may lead to impaired brain blood flow regulation.The expression of VCAM-1 in endothelial cells was elevated in inflammatory cytokines.Cell adhesion molecules increase intimal hyperplasia and vascular inflammation after vascular wall injury Clinical studies have shown that elevated sVCAM-1 and soluble intercellular adhesion molecule-1(sICAM-1)are associated with mild cognitive impairment in hypertensive patients.Objective:To determine the incidence and risk factors of postoperative cognitive dysfunction in elderly patients undergoing hip or knee arthroplasty and to investigate the related risk factors of elderly hypertensive patients with POCDMethods:88 patients aged at least 60 years undergoing hip or knee arthroplasty completed this study.Each patient completed a battery of cognitive tests on the day before surgery and the seventh day after surgery or before discharge.The battery included mini-mental state examination(MMSE),digit symbol test,digit span test,trails,Stroop test.Recorded the general information of patients,intraoperative and postoperative adverse events.The incidence of POCD was calculated using the Z score method.Risk factors of POCD was identified using the binary logistic regression analysis.Patients were divided into POCD group and non-POCD(NPOCD)group according to the occurrence of POCD.Take the test patients’peripheral blood before anesthesia induction,after entering the anesthesia recovery room and 24 hours after surgery.The soluble intercellular adhesion molecule-1(sICAM-1)and Soluble Vascular Cell Adhesion Molecule-1(sVCAM-1)was measured by ELISAResults:11 of the 88 patients had POCD,the incidence was 12.50%.There were 69 hypertensive patients in the 88 patients,and 9 of them had POCD,the incidence was 13.04%,19 patients without hypertension,and 2 of them had POCD,the incidence was10.53%.There was no significant difference in the incidence of POCD between patients with and without hypertension(P>0.05).The binary logistic regression analysis showed that the time of hypertension was a risk factor of POCD(OR=0.855,95%CI 为 0.751-0.974,P=0.018).Age,gender,height,weight,BMI,education level and the number of previous operations were not related to the incidence of POCD(P>0.05)Conclusion:The incidence of POCD in patients aged at least 60 years undergoing hip or knee arthroplasty is 12.50%.The history of long-term hypertension and the increase of triglyceride were the risk factors of POCD.Hypertensive patients with sACAM-1 and sICAM-1 were higher than non-hypertensive patients.The test results of MMSE,Stroop Test 1,Stroop Test 2,TrailsA are more conducive to the evaluation of POCD.