老年患者全身麻醉术后早期认知功能障碍的影响因素  

The Influencing Factors of Early Postoperative Cognitive Dysfunction after General Anesthesia in Elderly Patients

作　　者：闫俊 乔琳 郭华 陈沛 高亚亚 叶楠 杨莹 史雅锋 Yan Jun;Qiao Lin;Guo Hua;Chen Pei;Gao Yaya;Ye Nan;Yang Ying;Shi Yafeng(Xi'an Fifth Hospital,Xi'an 710082)

机构地区：[1]西安市第五医院,西安710082

出　　处：《国际老年医学杂志》2024年第6期669-674,共6页International Journal of Geriatrics

基　　金：陕西省自然科学基础研究计划重点项目(2021JZ-58);陕西省中医药管理局科研项目(SZY-KJCYC-2023-082);西安市创新能力强基计划-医学研究项目(24YXYJ0076)。

摘　　要：目的 探讨老年全身麻醉患者早期出现术后认知功能障碍(POCD)的影响因素。方法选取2021年10月—2023年10月于西安市第五医院行择期手术的全身麻醉住院的129例老年患者作为研究对象,记录患者术前的一般情况、基础疾病史及血红蛋白含量,经颅多普勒超声评估术前双侧大脑中动脉平均血流速度及屏气指数(BHI),记录术中麻醉时长、出血量及低体温、低血压的发生情况。通过简易精神状态量表(MMSE)评估老年患者术前1天及术后1周的认知功能,术后MMSE评分低于术前≥2分认为存在POCD。结果 术后发生POCD者36例为POCD组,其余93例未发生POCD者为非POCD组。POCD组文化程度低于非POCD组(P<0.05),高血压、冠心病、高脂血症、术中低血压、术中低体温比例均高于非POCD组(P<0.05),麻醉时长长于非POCD组(P<0.05),术中出血量多于非POCD组(P<0.05);术前1天,POCD组MMSE评分低于非POCD组(P<0.05);术后1周,POCD组MMSE评分低于术前1天且同时低于非POCD组(P<0.05);POCD组术前血红蛋白、BHI均低于非POCD组(P<0.05);多因素logistic回归结果提示:合并高血压、术中出血量是POCD发生的独立危险因素(P<0.05),术前血红蛋白和BHI是POCD发生的保护因素(P<0.05)。结论 高血压、血红蛋白、BHI、术中出血量是POCD出现的影响因素,对短期POCD出现有良好的预测价值,可用于全身麻醉术后认知功能下降的评估。Objective To investigate the influencing factors of early postoperative cognitive dysfunction(POCD)in elderly patients undergoing general anesthesia.Methods A total of 129 elderly patients hospitalized under general anesthesia who underwent elective surgery in Xi'an Fifth Hospital from October 2021 to October 2023 were selected as the study subjects.The preoperative general conditions,underlying disease history and hemoglobin content were recorded.The preoperative mean blood flow velocity of bilateral middle cerebral arteries and breath holding index(BHI)were assessed by transcranial doppler.The intraoperative anesthesia time,blood loss,hypothermia and hypotension were recorded.Cognitive function was assessed by the Mini-Mental State Examination(MMSE)1 day before surgery and 1 week after surgery in elderly patients,and POCD was considered to be present if the postoperative MMSE score was lower than≥2 points before surgery.Results A total of 36 patients who developed POCD after surgery were in the POCD group,and the remaining 93 patients who did not develop POCD were in the non-POCD group.POCD group education level was lower than non-POCD group(P<0.05),hypertension,coronary heart disease,hyperlipidemia,intraoperative hypothermia,intraoperative hypotension ratio were higher than non-POCD group(P<0.05),anesthesia duration was given in non-POCD group(P<0.05),intraoperative blood loss was more than non-POCD group(P<0.05).1 day before surgery,POCD group MMSE score was lower than non-POCD group(P<0.05).1 week after surgery,POCD group MMSE score was lower than 1 day before surgery and also lower than non-POCD group(P<0.05).The hemoglobin and BHI of the POCD group were all lower thah those in the non-POCD group(P<0.05).Multivariate logistic regression results suggested that:combined hypertension,intraoperative blood loss were independent influencing factors for the occurrence of POCD(P<0.05),while preoperative hemoglobin and BHI were protective factors for the occurrence of POCD(P<0.05).Conclusion Hypertension,hemoglobi

关 键 词：术后认知功能障碍 危险因素 血红蛋白 脑血流动力学 

分 类 号：R614[医药卫生—麻醉学]