论文部分内容阅读
目的:探讨术后谵妄患者脑脊液中胆碱能及单胺类神经递质水平的变化。方法:纳入68例术前认知功能正常的脊柱脊髓外科手术患者，术前诊断为椎管内髓外硬膜下良性占位性病变，其中18例发生术后谵妄(谵妄组)，46例未发生术后谵妄(对照组)，4例诊断不明确(剔除)。于病灶切除术前及术后第3天收集脑脊液，采用高效液相色谱/电化学检测法测定乙酰胆碱(Ach)、去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)、5-羟色胺(5-HT)的浓度。结果:病灶切除术前谵妄组与对照组脑脊液中Ach、NE、E、DA、5-HT的基线水平均差异无统计学意义(均n P>0.05)。手术后，谵妄组脑脊液中Ach水平[(0.63±0.26)μmol/L]显著低于对照组[(0.77±0.19)μmol/L](n P＝0.032)；其他神经递质水平均差异无统计学意义(均n P>0.05)。谵妄组患者中，手术后脑脊液中Ach水平[(0.63±0.26)μmol/L]较基线水平[(0.75±0.19)μmol/L]显著降低(n P＝0.021)；NE水平[(1.58±0.28)μmol/L]较基线水平[(1.49±0.21)μmol/L]显著升高(n P＝0.036)；肾上腺素水平无显著变化(n P＝0.497)；DA水平[(0.86±0.18)μmol/L]较基线水平[(0.82±0.15)μmol/L]显著升高(n P＝0.045)；5-HT水平[(2.94±0.28)μmol/L]亦较基线水平[(2.75±0.35)μmol/L]显著升高(n P＝0.022)。对照组患者中，仅5-HT水平[(2.90±0.31)μmol/L]较基线水平[(2.76±0.26)μmol/L]显著升高(n P＝0.016)，其他神经递质水平与基线水平相比均差异无统计学意义(均n P>0.05)。n 结论:术后谵妄患者的脑脊液中胆碱能神经递质水平降低而单胺类神经递质水平升高，由此可推测胆碱能神经系统活性减弱和单胺能神经系统过度兴奋或许是术后谵妄发生发展的重要病理生理环节。“,”Objective:To investigate the alterations of cholinergic and monoamine neurotransmitters in cerebrospinal fluid in patients with postoperative delirium.Methods:Sixty-eight patients with normal preoperative cognitive functions were enrolled.They were diagnosed with spinal extramedullary intradural space-occupying lesion and underwent surgical resection.Among these patients, 18 developed postoperative delirium (delirium group), 46 had no postoperative delirium (control group), and the diagnosis of delirium was unclear in four cases (excluded). Cerebrospinal fluid (CSF) was collected before the surgical resection of lesions and on the third day postoperatively.The concentrations of acetylcholine (Ach), norepinephrine (NE), adrenaline (E), dopamine (DA) and serotonin (5-HT) were measured using the high-performance liquid chromatography/electrochemical method.Results:Prior to the surgical resection, there were no significant differences in the Ach, NE, E, DA or 5-HT baseline levels in the CSF between the delirium group and the control group (all n P>0.05). After surgery, the Ach level in the delirium group ((0.63±0.26) μmol/L) was significantly lower than that in the control group ((0.77±0.19) μmol/L) (n P=0.032), and there were no significant differences in other neurotransmitter levels (all n P>0.05). In the delirium group, the level of Ach in the CSF after surgery ((0.63±0.26) μmol/L) was significantly lower than the baseline level ((0.75±0.19) μmol/L) (n P=0.021). The postoperative NE level ((1.58±0.28) μmol/L) was significantly higher than the baseline level ((1.49±0.21) μmol/L) ( n P=0.036). There was no significant difference in the adrenaline level (n P=0.497). The postoperative DA level ((0.86±0.18) μmol/L) was significantly higher than the baseline level ((0.82±0.15) μmol/L) ( n P=0.045), and the postoperative 5-HT level ((2.94±0.28) μmol/L) was also significantly higher than the baseline level ((2.75±0.35) μmol/L) ( n P=0.022). In the control group, only the postoperative 5-HT level ((2.90±0.31) μmol/L) was significantly higher than the baseline level ((2.76±0.26) μmol/L) ( n P=0.016), while the postoperative levels of other neurotransmitters were not significantly changed when compared to the baseline levels (all n P>0.05).n Conclusion:The cholinergic neurotransmitter levels were reduced while the monoamine neurotransmitter levels were increased in the cerebrospinal fluid in patients with postoperative delirium, which suggests that cholinergic hypoactivity and monoaminergic hyperexcitability may be important pathophysiological processes in the occurrence and development of postoperative delirium.