术后炎性反应在老年体外循环心脏手术患者认知功能下降中的作用：一项前瞻性对照研究
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Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery: a controlled,prospective observational study
背景与目的
非感染性炎性反应（IR）在术后认知功能障碍（POCD）发病病因中的作用仍然存在争议。这项前瞻性对照研究的目的在于评估心脏手术中以血清降钙素原（PCT）改变来定义的IR程度和POCD进展之间的关系。
方 法
本研究纳入年龄≥60岁，择期心脏手术的42例患者。根据术后第一天测得PCT结果随机分为低炎性反应组（LIR）和高炎性反应组（HIR）。从基层医疗机构中纳入了一个相匹配的含有32名受试者的规范性对照组。术后五天内每天监测PCT和C反应蛋白（CRP）水平。术前和术后第七天进行五项神经认知功能测试和两项情绪测试。使用规范的对照组数据得出的改良可信改变指数（RCIP）来确定效能是否显著下降。
结 果
LIR组（n = 20）和HIR组（n= 22）的PCT存在显著差异（P＜0.001），但与CRP的改变时点不一致。在队列中术后第一周POCD的发生率为35.7%。LIR和HIR组的神经认知功能测试RCIP Z分数和POCD发生概率结果均没有统计学差异（分别为7和8例，P＞0.05）。此外，情绪状态评分、焦虑水平等已知围术期影响POCD发生的因素也均没有统计学差异。
结论：这项研究表明，在体外循环心脏手术中非感染性炎性反应对老年患者术后早期POCD的发生不产生影响
结 论
这项研究表明，在体外循环心脏手术中非感染性炎性反应对老年患者术后早期POCD的发生不产生影响。
原始文献摘要
Nemeth E, Vig K, Racz K, et al. Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery: a controlled, prospective observational study[J]. Bmc Anesthesiology, 2017, 17(1):113.
Background: The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery.
Methods: Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance.
Results: The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p < 0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was 35.7% in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05).Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD.
Conclusions: In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients.
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