维生素D水平与老年患者围术期认知功能障碍的相关性分析

Correlation Analysis of Vitamin D Levels and Perioperative Cognitive Dysfunction in Elderly Patients

摘要: 目的：探讨术前维生素D水平对老年患者围术期认知功能的影响及维度。方法：纳入2023年12月~2025年6月浙大四院行膝/髋置换术的老年患者119例，检测术前血清维生素D水平，采用MMSE、MoCA、TMT-A评估围术期认知功能，比较痴呆与非痴呆组维生素D水平及缺乏情况。结果：术前维生素D缺乏27例(22.7%)，术前痴呆31例(26.1%)。痴呆组维生素D缺乏比例更高(P = 0.013)，且二者存在相关性(Phi = 0.227)。维生素D缺乏组术前认知功能更差(MMSE、MoCA更低，TMT-A耗时更长，P < 0.05)；维生素D水平与即刻记忆、注意力计算力、视空间执行及命名呈正相关(P < 0.05)，但与术后谵妄、术后认知下降无关。结论：维生素D缺乏与老年患者术前痴呆存在相关性，具体表现在即刻记忆、注意力和计算力、视空间与执行力、命名等能力。

Abstract: Objective: To investigate the effects and dimensions of preoperative vitamin D levels on perioperative cognitive function in elderly patients. Methods: 119 elderly patients who underwent knee/hip replacement surgery at the Fourth Affiliated Hospital of School of Medicine, Zhejiang University from December 2023 to June 2025 were included. Preoperative serum vitamin D levels were measured. Perioperative cognitive function was assessed using MMSE, MoCA, and TMT-A. Vitamin D levels and deficiency were compared between dementia and non-dementia groups. Results: 27 patients (22.7%) had preoperative vitamin D deficiency, and 31 patients (26.1%) had preoperative dementia. The proportion of vitamin D deficiency was higher in the dementia group (P = 0.013), and there was a correlation between the two groups (Phi = 0.227). The vitamin D deficiency group had poorer preoperative cognitive function (lower MMSE and MoCA, longer TMT-A time, P < 0.05). Vitamin D levels were positively correlated with immediate memory, attentional calculation ability, visuospatial executive function, and naming ability (P < 0.05), but not with postoperative delirium or postoperative cognitive decline. Conclusion: Vitamin D deficiency is associated with preoperative dementia in elderly patients, specifically in terms of immediate memory, attention and calculation ability, visuospatial and executive function, and naming ability.