60岁以上行髋关节或膝关节置换术患者术后认知功能障碍的发生率和危险因素  

Incidence and risk factors of postoperative cognitive dysfunction in patients aged at least 60 years undergoing hip or knee arthroplasty

作　　者：陈灵科[1] 郑丽[1] 吴广喜 郑华容[1] 陈杰[1] 王祥瑞[1] 俞卫锋[1] 苏殿三[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127

出　　处：《上海医学》2016年第2期80-84,共5页Shanghai Medical Journal

基　　金：国家自然科学基金(81271220);上海市科学技术委员会项目(12410709500)资助

摘　　要：目的研究60岁以上行髋关节或膝关节置换术的患者术后认知功能障碍（POCD）的发生率和危险因素。方法89例60岁以上择期行髋关节或膝关节置换术的患者纳入本前瞻性研究，最终53例患者完成研究。每例患者在手术前1～3d和术后7d或出院前进行认知功能测试，包括术前简易智能精神状态检查量表（MMsE）评分、视觉再现、数字符号、数字广度、颜色追踪测试（CTT）、色字干扰测试。收集患者的一般资料，术中记录手术方式、手术时间、出血量、麻醉用药、患者的生命体征和各种不良事件，术后记录各种并发症和不良事件的发生情况。采用Z分数的方法定义患者是否发生POCD，采用多因素Logistic回归分析POCD发生的危险因素。结果53例患者中9例发生POCD，发生率为17．0％；行髋关节置换术的患者POCD发生率为18．4％（7／38），行膝关节置换术的患者为2／15，两种手术患者POCD发生率的差异无统计学意义（P〉0．05）。发生POCD患者的年龄显著大于未发生POCD的患者（P〈0．05）。多因素Logistic逐步回归分析结果显示，年龄是POCD发生的危险因素（OR=1．138，95％CI为1．006～1．287，P〈0．05），性别、身高、体重、受教育时间、高血压、糖尿病、手术时间、出血量、术中麻黄素用量和术后使用镇痛泵对POCD的发生均无显著影响（P值均〉0．05）。结论60岁以上行髋关节或膝关节置换术患者的POCD发生率是17．0％，年龄是其发生POCD的危险因素。Objective To determinate the incidence and potential risk factors of postoperative cognitive dysfunction （POCD） in patients aged at least 60 years undergoing hip or knee arthroplasty. Methods A total of 89 patients aged at least 60 years undergoing hip or knee arthroplasty wereenrolled in this prospective study, and 53 patients finally completed the study. Each enrolled participant underwent a battery of neurocognitive tests which were administered 1 - 3 days before surgery, on the 7^th day after surgery or before discharge. The cognitive tests included mini-mental state examination （MMSE）, visual reproduction test, digit symbol test, digit span test, color trail test （CTT）, Stroop color and word test. Patients＇ general information was documented before surgery. Operation method, operation time, bleeding, anesthetics, patient＇s vital signs and a variety of adverse events were recorded during the surgery. Postoperative complications and adverse events were also recorded until hospital discharge. The incidence of POCD was calculated using the Z-score method. A multivariable logistic stepwise regression model was used to identify risk factors of POCD. Results POOD occurred in 9 of the 53 patients, and the incidence was 17.0 %. The incidence of POCD after hip arthroplasty and knee arthroplasty was 18.4 % （7/38） and 2/15, respectively, and there was no significant difference in the incidence of POOD between hip arthroplasty and knee arthroplasty （P〉0.05）. The age of the patients with POOD was significantly greater than those without POCD （P〈0.05）. Multivariable Logistic stepwise regression analysis showed that age was a risk factor of POCD （ OR = 1. 138, 95 % Cl, 1. 006 - 1. 287, P〈0.05）, while gender, height, weight, education level, hypertension, diabetes, surgical duration, bleeding volume, intraoperative ephedrine dosage and the use of postoperative patient controlled analgesia were not related to the occurrence of POCD （all P〉0.05）. Conclusion The incidence of POCD in p

关 键 词：术后认知功能障碍 手术 危险因素 老年 

分 类 号：R614[医药卫生—麻醉学]