新辅助化疗对老年患者单肺通气手术后认知功能障碍的影响  

Effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction in elderly patients after one-lung ventilation surgery

作　　者：王凯元[1] 刘玲[1] 李锦成[1] 唐鹏[2] 李惠霞[2] 段晓峰[2] 

机构地区：[1]天津医科大学肿瘤医院麻醉科、国家肿瘤临床研究中心、天津市肿瘤防治重点实验室,天津市300060 [2]天津医科大学肿瘤医院食管肿瘤科

出　　处：《中国肿瘤临床》2014年第12期801-805,共5页Chinese Journal of Clinical Oncology

基　　金：天津医科大学肿瘤医院科研项目(编号:1215)资助~~

摘　　要：目的：探讨术前新辅助化疗对单肺通气（one lung ventilation，OLV）手术老年患者术后早期认知功能障碍（post-opera-tive cognitive dysfunction，POCD）的影响。方法：选取90例行择期食管癌根治术的患者（包括两野淋巴结清扫术和三野淋巴结清扫术），年龄≥60岁，ASA分级Ⅰ～Ⅱ级，肿瘤临床TNM分期Ⅱ～Ⅲ期，随机分为新辅助化疗组（N组）和对照组（C组），每组各45例。患者均分别在术前1 d和术后7 d接受神经心理学测试以评估认知功能改变，根据Z值法判断POCD发生情况。结果：N组44例及C组41例术后顺利完成神经心理学测试。两组患者人口统计学资料、肿瘤分期和术中及术后临床资料相比无显著性差异。N组患者术后7 d 21例（47.7%）发生POCD，C组患者术后7 d 11例（26.8%）发生POCD。两者相比差异有统计学意义（χ2=3.949，P=0.047）。结论：新辅助化疗会加重老年患者OLV手术术后早期认知功能的损害，显著增加POCD发病率。Objective：We aimed to investigate the effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction （POCD） in elderly patients who underwent one-lung ventilation （OLV） surgery. Methods：A total of 90 esophageal carcinoma patients aged 60 years old or older were included. These patients were scheduled for esophagectomy, including two or three-field lymphadenec-tomy, and were randomly divided into two groups based on the American Society of Anesthesiologists status （Ⅰ or Ⅱ） and the Tu-mor-Node-Metastasis （TNM） classification stage （ⅡorⅢ）, as follows：the neo-adjuvant chemotherapy group （Group N：n=45） that re-ceived preoperative neo-adjuvant chemotherapy;and the control group （Group C：n=45） that did not receive chemotherapy. The neuro-psychological test was performed 1 d before and 7 d after surgery to evaluate the changes in cognitive function. The incidence of POCD was also determined via the Z-value method in the two groups. Results：A total of 44 patients in Group N and 41 patients in Group C completed the neuropsychological tests. No statistical differences were observed in the demographics, TNM stage, and the intra-and post-operative clinical data between the groups. POCD was observed in 21 of the patients in Group N （47.7%） and 11 of the patients in Group C （26.8%）, and the differences were significant （χ2=3.949, P=0.047）. Conclusion：Neo-adjuvant chemotherapy can aggravate the impairment of cognitive function in the elderly patients undergoing OLV surgery and can significantly increase the incidence of POCD.

关 键 词：化学疗法 单肺通气 老年人 认知障碍 

分 类 号：R735.1[医药卫生—肿瘤]