肝癌患者肝部分切除术后认知功能障碍的危险因素分析与护理对策  

Risk factors for postoperative cognitive dysfunction and nursing intervention after partial hepatectomy in patient with hepatocellular carcinoma

作　　者：吕静[1] 陈似霞[1] 彭涛[1] 李佳梅[1] 李春兰[1] 潘锡屏[1] 

机构地区：[1]广西医科大学第一附属医院十楼肝移植病区,南宁市530021

出　　处：《护理实践与研究》2013年第24期1-5,共5页Nursing Practice and Research

基　　金：广西壮族自治区卫生厅科研资助项目(Z2012123)

摘　　要：目的:探讨肝癌患者肝部分切除术后认知功能障碍(POCD)的危险因素。方法:选择在我院行肝部分切除术的肝癌患者426例,分别在术前7 d和术后7 d采用中文版简易精神状态检查量表进行认知功能评估,按是否发生POCD分为POCD组和非POCD组。收集两组患者性别、年龄和体质指数等共14个相关因素,通过单因素和多因素Logistic回归分析,筛选肝癌患者肝部分切术后POCD的独立危险因素。结果:408例患者完成本研究,其中95例发生POCD,发生率为23.28%。单因素分析显示,年龄、文化程度、嗜酒、高血压、糖尿病、肝功能Child-Pugh分级、肿瘤大小、手术时间、术中低血压和术后持续镇痛在两组间比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、嗜酒、高血压、肝功能Child-Pugh分级、肿瘤大小和术中低血压是肝癌患者肝部分切除术后POCD的独立危险因素(P<0.05),文化程度是其保护因素(P<0.05)。结论:POCD是肝癌患者肝部分切除术后常见并发症,通过积极的护理干预,可减少患者POCD的发生。Objective：To investigate the risk factors for postoperative cognitive dysfunction and nursing intervention after partial hepatectomy in patients with hepatocelhilar carcinoma. Methods ： A total of 426 patients undergoing partial hepatectomy were chose in this study. Those patients were divided into POCD group and non - POCD group by the mini - mental state examination （MMSE） at 7 days pre - and post - op- eration respectively. The gender, age, body mass index and other 11 related factors were collected. The related factors for the POCD after partial hepatectomy were statistically analyzed by univariate and multivariate binary logistical regression. Resuhs：408 patients completed the study,95 （ 23.28% ） developed POCD. Univariate analysis showed that age, level of education, drinking, hypertension, diabetes, grade of Child - Pugh, size of tumor, duration of surgery, intra - operative hypotension and postoperative analgesia were significantly different between the two groups （ P 〈 0.05 ）. Multivariate binary logistical regression analysis revealed that age, drinking, hypertension, grade of Child - Pugh, size of tumor and intra - operative hypotension were the independent risk factors of POCD （ P 〈 0.05 ）, and the level of educational was a protective factor of POCD （ P 〈 0.05 ）. Conclusion ： POCD is a common complication after partial hepatectomy in patients with hepatocellular carcinoma,and active nursing intervention can reduce the occurrence of POCD.

关 键 词：肝癌 肝部分切除术 认知功能障碍 危险因素 护理对策 

分 类 号：R473.73[医药卫生—护理学]