老年结直肠癌患者根治术后认知功能障碍的高危因素分析  

Risk factors of cognitive disfunction in elderly patients with postoperative colorectal cancer

作　　者：张明金 王仕琛[1] 李洋[1] 陈尚传 何俊峰 黄卫锋 ZHANG Ming-jin;WANG Shi-chen;LI Yang;CHEN Shang-chuan;HE Jun-feng;HUANG Wei-feng(Department of General Surgery,the 901st Hospital of the Joint Logistics Support Force of the PLA,230031Hefei,Anhui,China;Haimen District People’s Hospital of Nantong,226100Nantong,Jiangsu,China)

机构地区：[1]中国人民解放军联勤保障部队第901医院普外科,安徽合肥230031 [2]南通市海门区人民医院,江苏南通226100

出　　处：《临床消化病杂志》2023年第2期126-130,共5页Chinese Journal of Clinical Gastroenterology

基　　金：江苏省医学会医学科学(No:2021-JYA061)。

摘　　要：[目的]分析老年结直肠癌患者根治术的术后认知功能障碍(postoperative cognitive disfunction,POCD)高危因素,探讨防范措施,提升老年结直肠癌根治术患者围术期安全及预后质量。[方法]选择行结直肠癌根治术的老年患者228例为研究对象。术后2 d采用MMSE评分(2 d MMSE评分)对患者进行认知功能测评,较术前2 d MMSE评分下降2分为POCD者(观察组,57例),其他为认知功能正常者(对照组,171例)。收集整理2组患者个体资料及临床资料行组间比较,组间比较有差异的指标纳入多因素Logistic行高危因素分析。[结果](1)单因素分析显示,年龄、受教育时间、合并疾病、术前ASA分级、舒芬太尼用量、术中显著低氧血症、术中显著低血压、术中输血量、术后SIRS评分、术后是否符合入住ICU指征与POCD发生相关;(2)多因素Logistic分析显示,合并糖尿病、合并高血压、术中显著低氧血症、术中显著低血压、术后SIRS评分≥3分、术后符合入住ICU指征为发生POCD的高危因素。[结论]老年结直肠癌患者麻醉根治术发生POCD的高危因素以患者个体特征及术中关键指标的控制为主,术中应严密监测患者血压、血氧等关键指标,降低对患者中枢神经的刺激,降低发生POCD概率,以期提升患者术后及远期生存质量。[Objective]To analyze the high risk factors of postoperative cognitive disfunction(POCD)in elderly patients with colorectal cancer,and to explore preventive measures to improve perioperative safety and prognosis quality of elderly patients with colorectal cancer after radical operation.[Methods]The totals of 228elderly patients who underwent radical resection of colorectal cancer in our hospital from January 2017to December 2020were selected as the study subjects.The patients were divided into observation group(57cases)with POCD disorder and control group(171cases)with normal cognitive function according to the difference of MMSE score between 2days before operation and 2days after operation.Individual data and clinical data of the two groups were collected and compared between groups.Indicators with differences between groups were included in multivariate logistic analysis of high-risk factors.[Results](1)The single factor analysis of POCD in the early stage after radical operation showed that age,education time,complications,preoperative ASA classification,sufentanil dosage,intraoperative significant hypoxemia,intraoperative significant hypotension,intraoperative blood transfusion volume,SIRS score,and whether ICU indications were met after operation;(2)Multivariate logistic analysis showed that glycosuria was complicated.Disease,hypertension,intraoperative marked hypoxemia,intraoperative marked hypotension,SIRS score(>3)after operation and ICU indication after operation are the high risk factors for POCD in elderly patients with colorectal cancer after anesthesia and radical operation.[Conclusion]The high risk factors of early cognitive impairment in elderly patients with colorectal cancer after radical anesthesia are patient’s individual characteristics and the control of key intraoperative indicators.The key indicators such as blood pressure and blood oxygen are closely monitored during the operation to reduce the stimulation of the patient’s central nervous system and the incidence of early POCD after o

关 键 词：结直肠癌 麻醉 术后认知功能障碍 

分 类 号：R735.3[医药卫生—肿瘤]