Relationship between cholinergic biomarkers and postoperative delirium in elderly patients / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the relationship between cholinergic biomarkers and postoperative delirium (POD) in elderly patients.Methods:The patients, aged 65-85 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, underwent total knee/hip arthroplasty under combined spinal-epidural block in our hospital from July 2018 to September 2019, were collected.The baseline clinical data of patients were collected, and cubital venous blood samples 5 ml were collected before anesthesia to detect plasma concentrations of choline acetyltransferase (ChAT), acetylcholinesterase (AChE), butyrylcholinesterase (BuChE), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). The neuropsychological testing was performed on 1 day before operation, following admission to the recovery room after surgery, and on 1, 3 and 7 days (or before discharge) after surgery.The patient′s cognitive function was assessed using Mini-Mental State Examination (MMSE) before surgery.Confusion Assessment Method and Memorial Delirium Assessment Scale were used to evaluate the occurrence of postoperative delirium (POD) after surgery.The patients were divided into POD group (P group) and non-POD group (NP group) according to whether POD occurred.Logistic regression was used to analyze the related risk factors for POD.Results:There were 349 cases in NP group and 57 cases in P group, and the incidence of POD was 14.0%.Compared with NP group, the age of patients, preoperative coexisting underlying diseases (≥3 types), plasma ChAT, TNF-α and IL-6 concentrations were increased, and plasma AChE and BuChE concentrations were decreased in P group ( P<0.05). The results of multivariate logistic regression analysis showed that changes in plasma AChE, BuChE, and ChAT concentrations and older age were independent risk factors for POD ( P<0.05). Conclusion:The development of POD is related to the preoperative changes in plasma AChE, BuChE and ChAT concentrations in elderly patients.