不同时间点脑血流量与脑氧代谢率比值对老年食管癌患者术后认知功能障碍的预测价值  

Predictive value of ratio of cerebral blood flow to cerebral metabolic rate of oxygen at different time points on postoperative cognitive dysfunction in elderly patients with esophageal carcinoma

作　　者：李雪萌 陈永学[1] 魏红芳[1] 王新波[1] 武一平 朱希燕[4] LI Xuemeng;CHEN Yongxue;WEI Hongfang;WANG Xinbo;WU Yiping;ZHU Xiyan(Department of Anesthesiology,Handan Central Hospital,Handan 056008,Hebei,China;Graduate School,Hebei North University,Zhangjiakou 075032,Hebei,China;Department of Neurology,Handan Central Hospital,Handan 056008,Hebei,China;Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]邯郸市中心医院麻醉科,河北省邯郸市056008 [2]河北北方学院研究生学院,河北省张家口市075032 [3]邯郸市中心医院神经内科,河北省邯郸市056008 [4]河北医科大学第四医院胸外科,河北省石家庄市050000

出　　处：《广西医学》2023年第10期1168-1171,1183,共5页Guangxi Medical Journal

基　　金：河北省医学科学研究课题计划(20200478)。

摘　　要：目的探讨不同时间点脑血流量/脑氧代谢率(CBF/CMRO_(2))值对老年食管癌患者术后认知功能障碍(POCD)的预测价值。方法选取140例行手术治疗的老年食管癌患者,根据术后蒙特利尔认知评估(MoCA)量表评分将其分为A组(POCD患者)58例和B组(非POCD患者)82例。比较两组患者的一般资料,以及麻醉诱导前(T_(1))、麻醉诱导后2 h(T_(2))、麻醉诱导后24 h(T_(3))、麻醉诱导后48 h(T_(4))的颈静脉球部血氧饱和度(SjvO_(2))和CBF/CMRO_(2)值。绘制受试者工作特征(ROC)曲线,评估不同时间点CBF/CMRO_(2)值对老年食管癌患者发生POCD的预测价值。结果两组患者的SjvO_(2)比较,差异无统计学意义(P>0.05)。两组患者的CBF/CMRO_(2)值比较,差异有统计学意义(P<0.05),两组的CBF/CMRO_(2)值均有随时间变化的趋势(均P<0.05),其中A组T_(2)、T_(3)时的CBF/CMRO_(2)值均低于B组(均P<0.05)。ROC曲线分析结果显示,T_(1)、T_(2)、T_(3)、T_(4)的CBF/CMRO_(2)值预测老年食管癌患者发生POCD的曲线下面积(AUC)分别为0.521、0.821、0.698、0.555,其中T_(1)与T_(4)的AUC差异无统计学意义(P>0.05),而T_(2)、T_(3)、T_(4)的AUC依次降低(均P<0.05)。结论CBF/CMRO_(2)值与老年食管癌患者发生POCD相关,麻醉诱导后2 h监测CBF/CMRO_(2)值能较好地预测老年食管癌患者POCD的发生。Objective To investigate the predictive value of cerebral blood flow/cerebral metabolic rate of oxygen(CBF/CMRO_(2))value at different time points on postoperative cognitive dysfunction(POCD)in elderly patients with esophageal carcinoma.Methods A total of 140 elderly patients with esophageal carcinoma undergoing surgical treatment were selected,and they were assigned to group A(POCD patients,58 cases)or group B(non-POCD patients,82 cases)according to the postoperative Montreal Cognitive Assessment(MoCA)scale score.The general data,and jugular venous bulb oxygen saturation(SjvO_(2))and CBF/CMRO_(2)value before anesthesia induction(T_(1)),2 hours after anesthesia induction(T_(2)),24 hours after anesthesia induction(T_(3)),48 hours after anesthesia induction(T_(4))were compared between the two groups.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of CBF/CMRO_(2)value at different time points on the occurrence of POCD in elderly patients with esophageal carcinoma.Results There was no statistically significant difference in SjvO_(2)of patients between the two groups(P>0.05).There was a statistically significant difference in CBF/CMRO_(2)value between the two groups(P<0.05),and CBF/CMRO_(2)value in both groups exhibited a trend of changes over time(all P<0.05),therein group A yielded lower CBF/CMRO_(2)value at T_(2)and T_(3)as compared with group B(all P<0.05).The results of ROC curve analysis revealed that the areas under the curve(AUC)of CBF/CMRO_(2)value at T_(1),T_(2),T_(3),and T_(4)in predicting the occurrence of POCD in elderly patients with esophageal carcinoma were 0.521,0.821,0.698,and 0.555,among which no statistically significant difference in AUC was found between T_(1)and T_(4)(P>0.05),whereas AUC at T_(2),T_(3),and T_(4)was decreased successively(all P<0.05).Conclusion CBF/CMRO_(2)value is related to the occurrence of POCD in patients with esophageal carcinoma,monitoring CBF/CMRO_(2)value at 2 hours after anesthesia induction can preferably predict the occurrenc

关 键 词：食管癌 术后认知功能障碍 脑血流量 脑氧代谢率 预测价值 老年人 

分 类 号：R735.1[医药卫生—肿瘤]