Risk factors for postoperative cognitive dysfunction after orthopedic surgery for adolescent idiopathic scoliosis / 中华麻醉学杂志

ABSTRACT

Objective To determine the risk factors for postoperative cognitive dysfunction (POCD) after orthopedic surgery for adolescent idiopathic scoliosis.Methods Sixty-five patients with adolescent idiopathic scoliosis,aged 11-18 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective orthopedic surgery with general anesthesia,were enrolled in this study.On admission to hospital (T0),before surgery (T1),at the end of surgery (T2) and on 2nd day after surgery (T3),blood samples were taken from the peripheral vein for determination of serum interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) concentrations.Cognitive function was evaluated using a set of neuropsychological tests at 1 day before surgery and 7 days after surgery.Baseline patient characteristics such as age,gender,years of education and medical history,intraoperative fluid intake and output,surgery time,extubation time,postoperative visual analog scale score and related complications were recorded.Patients were divided into either POCD group or non-POCD group according to the diagnostic criteria of POCD.Logistic regression analysis was used to pick out the risk factors for POCD.Results Sixty-three patients completed this trial.The incidence of POCD was 24％.Compared with non-POCD group,the serum IL-10 concentration at T0 and serum TNF-α concentration at T3 were significantly increased,the IL-10/TNF-α ratio was decreased,and the length of postoperative hospital stay was prolonged in POCD group (P＜0.05).The results of logistic regression analysis showed that increased concentrations of serum IL-10 at T0 and TNF-α at T3 were risk factors for POCD.Conclusion Increased serum concentrations of IL-10 on admission to hospital and TNF-α on 2nd after surgery are risk factors for POCD in the patients with adolescent idiopathic scoliosis.