目的探讨全身麻醉与硬膜外麻醉两种手术麻醉方式对老年骨科患者术后短期认知功能的影响。方法选取2010年1月-2016年3月北京市大兴区红星医院骨科诊治的120例需行下肢骨折手术的患者，随机分为观察组与对照组。对照组以全身麻醉方式进行...目的探讨全身麻醉与硬膜外麻醉两种手术麻醉方式对老年骨科患者术后短期认知功能的影响。方法选取2010年1月-2016年3月北京市大兴区红星医院骨科诊治的120例需行下肢骨折手术的患者，随机分为观察组与对照组。对照组以全身麻醉方式进行骨科手术，观察组则以硬膜外麻醉方式进行骨科手术。比较2组患者术前、术后6h、24h、72h的简易精神状态检测量表（mini-mental State Examination，MMSE）评分及术后短期认知功能障碍（postoperative cognitive dysfunction，POCD）的发生率。结果与对照组相比，观察组术前MMSE评分无显著差异（P〉0．05）。两组术后6h、24h、72hMMSE评分明显高于术前，术后6h、72h的MMSE评分明显高于术后24h评分。且术后观察组同一时间点MMSE评分显著高于对照组，差异均有统计学意义（P〈O．05）观察组POCD发生率明显低于对照组，差异有统计学意义（P〈0．05）。结论在老年骨科患者的手术治疗中运用硬膜外麻醉方式进行骨科手术对患者认知功能影响更小，降低短期认知功能障碍发生率，进而改善预后，值得临床上进一步应用推广。展开更多
Accumulating evidence indicates that inhalation anesthetics induce or increase the risk of cognitive impairment. GLYX-13（rapastinel） acts on the glycine site of N-methyl-D-aspartate receptors（NMDARs） and has been ...Accumulating evidence indicates that inhalation anesthetics induce or increase the risk of cognitive impairment. GLYX-13（rapastinel） acts on the glycine site of N-methyl-D-aspartate receptors（NMDARs） and has been shown to enhance hippocampus-dependent learning and memory function. However, the mechanisms by which GLYX-13 affects learning and memory function are still unclear. In this study, we investigated these mechanisms in a mouse model of long-term anesthesia exposure. Mice were intravenously administered 1 mg/kg GLYX-13 at 2 hours before isoflurane exposure（1.5% for 6 hours）. Cognitive function was assessed using the contextual fear conditioning test and the novel object recognition test. The mRNA expression and phosphorylated protein levels of NMDAR pathway components, N-methyl-D-aspartate receptor subunit 2B（NR2B）-Ca2+/calmodulin dependent protein kinase II（CaMKII）-cyclic adenosine monophosphate response element binding protein（CREB）, in the hippocampus were evaluated by quantitative RT-PCR and western blot assay. Pretreatment with GLYX-13 ameliorated isoflurane exposure-induced cognitive impairment and restored NR2B, CaMKII and CREB mRNA and phosphorylated protein levels. Intracerebroventricular injection of KN93, a selective CaMKII inhibitor, significantly diminished the effect of GLYX-13 on cognitive function and NR2B, CaMKII and CREB levels in the hippocampus. Taken together, our findings suggest that GLYX-13 pretreatment alleviates isoflurane-induced cognitive dysfunction by protecting against perturbation of the NR2B/CaMKII/CREB signaling pathway in the hippocampus. Therefore, GLYX-13 may have therapeutic potential for the treatment of anesthesia-induced cognitive dysfunction. This study was approved by the Experimental Animal Ethics Committee of Drum Tower Hospital affiliated to the Medical College of Nanjing University, China（approval No. 20171102） on November 20, 2017.展开更多
文摘目的探讨全身麻醉与硬膜外麻醉两种手术麻醉方式对老年骨科患者术后短期认知功能的影响。方法选取2010年1月-2016年3月北京市大兴区红星医院骨科诊治的120例需行下肢骨折手术的患者，随机分为观察组与对照组。对照组以全身麻醉方式进行骨科手术，观察组则以硬膜外麻醉方式进行骨科手术。比较2组患者术前、术后6h、24h、72h的简易精神状态检测量表（mini-mental State Examination，MMSE）评分及术后短期认知功能障碍（postoperative cognitive dysfunction，POCD）的发生率。结果与对照组相比，观察组术前MMSE评分无显著差异（P〉0．05）。两组术后6h、24h、72hMMSE评分明显高于术前，术后6h、72h的MMSE评分明显高于术后24h评分。且术后观察组同一时间点MMSE评分显著高于对照组，差异均有统计学意义（P〈O．05）观察组POCD发生率明显低于对照组，差异有统计学意义（P〈0．05）。结论在老年骨科患者的手术治疗中运用硬膜外麻醉方式进行骨科手术对患者认知功能影响更小，降低短期认知功能障碍发生率，进而改善预后，值得临床上进一步应用推广。
基金supported by the National Natural Science Foundation of China,No.81730033(to XPG),81701371(to TJX),81801380(to XZ)Natural Science Foundation of Jiangsu Province of China,No.BK20170654(to TJX),BK20170129(to XZ)
文摘Accumulating evidence indicates that inhalation anesthetics induce or increase the risk of cognitive impairment. GLYX-13（rapastinel） acts on the glycine site of N-methyl-D-aspartate receptors（NMDARs） and has been shown to enhance hippocampus-dependent learning and memory function. However, the mechanisms by which GLYX-13 affects learning and memory function are still unclear. In this study, we investigated these mechanisms in a mouse model of long-term anesthesia exposure. Mice were intravenously administered 1 mg/kg GLYX-13 at 2 hours before isoflurane exposure（1.5% for 6 hours）. Cognitive function was assessed using the contextual fear conditioning test and the novel object recognition test. The mRNA expression and phosphorylated protein levels of NMDAR pathway components, N-methyl-D-aspartate receptor subunit 2B（NR2B）-Ca2+/calmodulin dependent protein kinase II（CaMKII）-cyclic adenosine monophosphate response element binding protein（CREB）, in the hippocampus were evaluated by quantitative RT-PCR and western blot assay. Pretreatment with GLYX-13 ameliorated isoflurane exposure-induced cognitive impairment and restored NR2B, CaMKII and CREB mRNA and phosphorylated protein levels. Intracerebroventricular injection of KN93, a selective CaMKII inhibitor, significantly diminished the effect of GLYX-13 on cognitive function and NR2B, CaMKII and CREB levels in the hippocampus. Taken together, our findings suggest that GLYX-13 pretreatment alleviates isoflurane-induced cognitive dysfunction by protecting against perturbation of the NR2B/CaMKII/CREB signaling pathway in the hippocampus. Therefore, GLYX-13 may have therapeutic potential for the treatment of anesthesia-induced cognitive dysfunction. This study was approved by the Experimental Animal Ethics Committee of Drum Tower Hospital affiliated to the Medical College of Nanjing University, China（approval No. 20171102） on November 20, 2017.
