老年患者行前列腺电切术后早期认知功能障碍与术后谵妄的相关性研究  

作　　者：邵一俪 于泳健[1] 

机构地区：[1]浙江省人民医院,310000

出　　处：《浙江临床医学》2016年第12期2216-2218,共3页Zhejiang Clinical Medical Journal

摘　　要：目的观察老年患者行经尿道前列腺电切术（TURP）术后早期认知功能障碍（POCD）的围术期相关危险因素，并探讨其与术后谵妄（POD）的相关性。方法本研究为前瞻性队列研究，以择期行TURP老年患者（〉65岁）为观察对象，麻醉方法为布比卡因单次腰麻复合右美托咪定静脉镇静，保证患者术中镇静深度维持于Ramsay评分Ⅲ-Ⅳ级。记录患者术前病史与基础资料。以及围术期POCD相关危险因素指标，于术后1-4d使用意识紊乱评估法（CAM）的CAM-ICU版本进行POD评估与诊断；术后第7天使用简易精神状态量表（MMSE）评估患者认知功能，并采用“一个标准差法”诊断POCD。结果86例行TURP老年患者（65-87岁）成功进行术后随访．结果显示POCD发生率为22．1％（19例），POD发生率为31．4％（27例）。其中，26例POD患者在术后前3d即发生谵妄（96．3％），且有16例POD患者在术后第7天发生POCD（61．5％）。经单因素分析继以多因素Logistic回归分析，结果显示早期POCD的独立危险因素包括年龄及POD持续时间。结论老年患者行TURP术后POCD与POD均具有较高发病率，且除年龄外，POD持续时间长是POCD另一独立危险因素。Objective This study was designed to investigate the incidence of postoperative cognitive dysfunction （ POCD ） in elderly patients with transurethral prostatectomy （ TURP ） and its perioperative risk factors, especially postoperative delirium （POD） . Method Elderly patients （ 〉 65years ） with elective TURP surgery were chosen for this prospective cohort study. The anesthesia method was bupivacaine spinal anesthesia combined with dexmedetomidine sedation, and the sedative depth was maintained to Ramsay scores Ⅲ or Ⅳ. The patients＇ basic data, medical histories, and POCD-related risk factors were recorded during the whole perioperative period. The POD was diagnosed by using confusion assessment method （CAM） -ICU on postoperative days 1-4, and the POCD was assesed with mini-mental state examination （MMSE） scale by using 1SD method on postoperative day 7. Results A total of 86 elderly patients （ 65 - 87 years ） were successfully followed up in this study. The incidence of POCD was 22.1% （ 19 patients ） while it was 31.4% （ 27 patients ） for POD, among of which 26 patients were diagnosed as POD on postoperative days 1-3, and 16 POD patients developed into POCD on postoperative day 7. The logistic analysis showed that the independent risk factors of early POCD were age and POD duration. Conclusions The incidences of POCD and POD of elderly patients under TURP surgery were both high. The age and POD duration were the independent risk factors for POCD.

关 键 词：经尿道前列腺电切术 谵妄 术后认知功能障碍 

分 类 号：R697.32[医药卫生—泌尿科学]