心理干预对老年结直肠癌患者术后认知功能及焦虑的影响  

Effect of psychological intervention on postoperative cognitive function and anxiety in elderly patients with colorectal cancer

作　　者：高晓军[1] 王胜[1] 代志刚[1] 高元丽[1] 张印龙[1] 于海[1] 葛明月 邢文龙 Xiao-jun Gao;Sheng Wang;Zhi-gang Dai;Yuan-li Gao;Yin-long Zhang;Hai Yu;Ming-yue Ge;Wen-long Xing(Department of Anesthesiology,the First Affiliated Hospital of the Medical College,Shihezi University,Shihezi,Xinjiang Uygur Autonomous Region 832008,China;Department of Rehabilitation Psychology,the First Affiliated Hospital of the Medical College,Shihezi University,Shihezi,Xinjiang Uygur Autonomous Region 832008,China)

机构地区：[1]石河子大学医学院第一附属医院麻醉科,新疆石河子832008 [2]石河子大学医学院第一附属医院康复心理科,新疆石河子832008

出　　处：《中国现代医学杂志》2018年第28期95-101,共7页China Journal of Modern Medicine

摘　　要：目的探讨围术期心理干预对老年结直肠癌患者术后认知功能及焦虑的影响。方法选取全身麻醉下行结直肠癌手术患者50例,年龄65~75岁,ASAⅠ、Ⅱ级,采用随机数字表法分为心理干预组(I组)和对照组(C组),每组25例。C组进行常规术前访视和术后随访,I组于术前、入手术室后、麻醉清醒后、术后2 d、术后5 d随访同时进行心理干预。记录术前2 d、入室后静卧5 min、麻醉诱导前即刻、切皮、术中2 h、术毕、拔管、术后1 d、术后3 d、术后7 d等10个时间点的血压(BP)、心率(HR);记录术前2 d、入室后静卧5 min、术后7 d、术后2周的焦虑自评量表(SAS)评分;于术前2 d、麻醉诱导前即刻、术毕、术后1、2、3 d收集血液标本,测定神经元特异性烯醇化酶(NSE)含量;于术前2 d、术后1、3、7 d,术后2周随访登记简易精神智能状态量表(MMSE)评分、连线测验(TMT)完成时间。结果与I组比较,C组入室后静卧5 min、术后7 d、术后2周的SAS评分升高且差异有统计学意义(P<0.05);术后1、3、7 d I组的MMSE评分高于C组,术后1、3、7 d I组的TMT完成时间短于C组,麻醉前诱导前即刻、术毕、术后1、2、3 d I组NSE含量低于C组,术后1、3、7 d C组POCD发生率高于I组,差异均有统计学意义(P<0.05)。结论围术期心理干预可改善老年结直肠癌患者焦虑状况,减少认知功能障碍的发生。Objective To investigate the effect of psychological intervention on postoperative cognitive function and anxiety in elderly patients undergoing surgery for colorectal cancer.Methods Fifty patients undergoing elective colorectal cancer surgery under general anesthesia were selected.They were aged 65-75 years and at ASA grade I-II,and divided into an observation group(group C)and a psychological intervention group(group I)by the random number table method with 25 cases in each group.The patients in the group C underwent routine preoperative visit and postoperative follow-up,and those in the group I received simultaneous psychological intervention before operation,after entering the operation room,after wakefulness,and during follow-up on the 2nd and 5th d after operation.BP and HR were recorded 2 d before operation,5 min after the patients entering the operating room,immediately before induction of anesthesia,at the time of incision,2 h after incision,at the end of surgery,at the time of extubation,1 d after surgery,3 d after surgery and 7 d after surgery.The score of Self-rating Anxiety Scale(SAS)was recorded 2 d before operation,after entering the operating room,7 d after surgery and 2 w after surgery.The blood samples were collected from the patients 2 d before operation,5 min before anesthesia induction,at the end of surgery,and 1,2 and 3 d after surgery to determine the content of neuron-specific enolase(NSE).The completion time of Mini-mental State Examination(MMSE)score and Trail Making Test(TMT)was recorded 2 d before surgery,and 1,3 and 7 d and 2 w after surgery.Results Compared with the group I,the SAS score of the group C significantly increased after entering the operating room,7 d and 2 w after surgery with statistical differences(P<0.05).Compared with the group I,the MMSE score of the group C was significantly reduced 1,3 and 7 d after surgery(P<0.05);and the TMT completion time of the group C was significantly prolonged 1,3 and 7 d after surgery(P<0.05).Compared with the group C,the blood level of N

关 键 词：围术期 心理干预 老年结直肠癌患者 术后认知功能障碍 焦虑 

分 类 号：R735.3[医药卫生—肿瘤]