| Objective The aim of this study is to evaluate the predictive value of preoperative plasma beta2 microglobulin(β2M)on postoperative delirium(POD)in aged patients following orthopedic surgery,and provide a reference for clinicians to strengthen the diagnosis and prevention of POD.Methods Two hundred and twenty-five patients with ASA Ⅱ-Ⅲ,aged 65 or older,scheduled for elective knee,hip arthroplasty or femoral head replacement were enrolled in this trial.According to the exclusion criterias,145 patients were enrolled in this study ultimately.ECG,Sp02,HR and IBP were continuously monitored when the patients entered the operating room,and oxygen with a flow rate of 5L/min was supplied via a mask.After the preparation is completed,lumbar spinal anesthesia were carried out in the L2-3 or L3-4 intervertebral space,and keeping the block plane less than or equal to T8.The hemodynamic indexes of patients were closely monitored,and keeping the range fluctuation less than 20%.If necessary vasoactive agents or blood transfusions will be given.One day before surgery,the patients were interviewed,and the gender,age,BMI,cultural level,smoking and drinking history,surgical history and the combination of diseases were recorded,MMSE scale was used to assess the cognitive function of the patients.Two milliliters peripheral venous blood were obtained before anesthesia to detect the content of β2M.All patients had patient-controlled intravenous analgesia at the end of the operation and the operation time,type of operation,amount of bleeding and blood transfusion were recorded.CAM assessment was performed for patients 1-3 days postoperatively.The patients were divided into two groups according to the occurrence of POD:the POD group(n=26)and the NonPOD group(n=119),the VAS scores and the hospital stay after operation were also recorded.Results Compared with NonPOD group,the age[(80.8±8.1)VS(73.9±6.2)years],ASA classification[(11/15)VS(94/25)cases]and the preoperative level ofβ2M[(3.4±1.0)VS(2.5±1.0)mg/L]were significantly increased in POD group(P<0.05),the preoperative albumin level[(36.3±3.7)VS(38.4±4.4)g/L],preoperative MMSE scores[(21.4±4.2)VS(24.3±3.8)points]were significantly decreased(P<0.05),the surgical time[(57.7±25.3)VS(78.3 ± 26.1)min]were also significantly decreased(P<0.05).There were also significant differences in surgical types[(7/3/16)VS(62/37/20)]between the the two groups(P<0.05).There was no statistically significant difference between the two groups in the other demographic datas and intraoperative,postoperative conditions(P>0.05).Logistic multifactor regression analysis showed that advanced age(OR=1.138,95%CI:1.042-1.242,P<0.05)and decreased preoperative MMSE scores(OR=0.831,95%CI:0.730-0.947,P<0.05)are the independent risk factors of POD.The area under the receiver operating characteristic curve is 0.806,suggesting that the model has good accuracy.Spearman correlation analysis showed that the β2M has a positive correlation with age in NonPOD group(r=0.269,P<0.05),while there is no significant correlation in POD group(r=0.468,P>0.05).Conclusions The preoperative plasma level of β2M can predict the occurrence of POD in aged patients following orthopedic surgery.The preoperative plasma β2M increased with age in NonPOD patients.Advanced age and decreased preoperative MMSE scores were independent risk factors for POD in aged patients following orthopedic surgery. |
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