血清OXA、pNF-H与前列腺癌TURP全身麻醉术后认知功能的关联OA

[Objective]To analyze the correlation between orexin A(OXA),phosphorylated neurofilament heavy subunit(pNF-H)and cognitive function in patients with prostate cancer undergoing transurethral resection of prostate(TURP)under general anesthesia,and their predictive value for postoperative delirium(POD).[Methods]Ninety-four prostate cancer patients admitted to the First Affiliated Hospital of Nanyang Medical College from March 2021 to March 2022 were selected retrospectively.All patients underwent TURP surgery under general anesthesia.Based on the occurrence of POD,the enrolled patients were divided into POD group(30 cases)and non-POD group(64 cases),and their general and clinical data were compared.Pearson correlation coefficient was used to test the correlation between serum OXA,pNF-H and cognitive function scores of prostate cancer patients.The risk factors of TURP general anesthesia POD were summarized through logistic multiple regression analysis.The predictive value of serum OXA and pNF-H for POD was verified by plotting receiver operating characteristic(ROC)curves and observing the area under the curve(AUC).[Results]The results of univariate analysis showed that the age,proportion of American Society of Anesthesiologists(ASA)anesthesia grade≥Ⅲ,proportion of concomitant cerebrovascular disease,proportion of concomitant hypoxemia,proportion of preoperative malnutrition,operation time,muscle relaxant dosage,postoperative extubation time,duration of stay in the Post-Anesthesia Care Unit(PACU),and average serum pNF-H levels in the POD group were higher than those in the non-POD group;the body mass index(BMI),intraoperative body temperature,serum OXA,Minimum Mental State Examination(MMSE)score,and Montreal Cognitive Assessment(MoCA)score in the POD group were all lower than those in the non-POD group(P＜0.05).Pearson correlation coefficient test showed a positive correlation between serum OXA and MMSE score,MoCA score(P＜0.05),and serum pNF-H and the MMSE score and MoCA score were negatively correlated(P＜0.05).Logistic multivariate regression analysis showed that age,dosage of muscle relaxants,intraoperative body temperature,postoperative extubation time,serum OXA,serum pNF-H,MMSE score and MoCA score were risk factors for postoperative POD after TURP general anesthesia.Through ROC curve validation,the sensitivity and specificity of serum OXA for predicting POD were 85.23%and 79.65%,respectively,while the sensitivity and specificity of serum pNF-H for predicting POD were 81.34%and 78.33%,respectively(AUC＞0.85).[Conclusion]Serum OXA is positively correlated with the degree of cognitive impairment in prostate cancer TURP patients after general anesthesia,while serum pNF-H is negatively correlated with the degree of cognitive impairment after general anesthesia.Dynamically monitoring serum OXA and pNF-H can achieve early prediction of POD.