预后营养指数变化对丙泊酚麻醉下结直肠癌手术后患者认知功能的影响  

The impact of prognostic nutritional index changes on cognitive function in colorectal cancer patients undergoing surgery with propofol anesthesia

作　　者：张龙堂 麦合普拜姆·伊力夏提 吴远哲 蔡小丽[1] Zhang Longtang;Maihepubim Ilixiati;Wu Yuanzhe;Cai Xiaoli(The Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang830000,China)

机构地区：[1]新疆医科大学第五附属医院,新疆乌鲁木齐830000

出　　处：《首都食品与医药》2025年第3期27-31,共5页Capital Food Medicine

摘　　要：目的探讨预后营养指数(PNI)变化对丙泊酚麻醉下结直肠癌手术后患者认知功能障碍(POCD)的影响.方法选取2016年1月-2021年12月在新疆医科大学第五附属医院接受丙泊酚全静脉麻醉下结直肠癌切除术的165例患者进行回顾性分析.根据简易精神状态量表(MMSE)将患者分为POCD组和对照组,并计算患者术前与术后PNI及变化情况(ΔPNI).构建多因素Logistic回归模型分析ΔPNI对认知功能的影响,采用3次回归限制样条(RCS)模型明确ΔPNI与POCD风险之间的剂量-反应关系.结果结直肠癌患者中共发现POCD47例,发生率为28.48%.与对照组相比,POCD组术后PNI及ΔPNI均处于更低水平,组间差异具有统计学意义(P<0.05).多因素Logistic回归结果显示,在调整体质指数、吸烟史、新辅助治疗等协变量后,ΔPNI升高仍与POCD低风险独立相关(OR=0.951,95%CI:0.913-0.991).RCS模型结果表明,ΔPNI与结直肠癌患者POCD之间总体呈负向线性相关(非线性P>0.05).结论高ΔPNI水平对丙泊酚麻醉下结直肠癌手术后患者认知功能具有潜在的保护作用,上述结论还需进一步的前瞻性队列研究和临床研究加以确证.Objective To investigate the impact of changes in the Prognostic Nutritional Index(PNI)on postoperative cognitive dysfunction(POCD)in colorectal cancer patients undergoing surgery with propofol anesthesia.Methods A retrospective analysis was conducted on 165 patients who underwent colorectal cancer resection under total intravenous anesthesia with propofol at the Fifth Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2021.Patients were divided into POCD group or control group based on the mini-mental state examination(MMSE).Preoperative and postoperative PNI values and changes(ΔPNI)were calculated.A multivariate Logistic regression model was constructed to analyze the impact ofΔPNI on cognitive function,and a restricted cubic spline(RCS)model was used to clarify the dose-response relationship betweenΔPNI and POCD risk.Results POCD was identified in 47 colorectal cancer patients,with an incidence rate of 28.48%.Compared to the control group,the POCD group had significantly lower postoperative PNI andΔPNI levels(P<0.05).Multivariate Logistic regression results indicated that after adjusting for covariates such as body mass index,smoking history,and neoadjuvant therapy,an increase inΔPNI was independently associated with a lower risk of POCD(OR=0.951,95%CI:0.913-0.991).The RCS model results showed a generally negative linear correlation betweenΔPNI and POCD risk in colorectal cancer patients(P_(non-linear)>0.05).Conclusion A highΔPNI level has a potential protective effect on cognitive function in colorectal cancer patients undergoing surgery with propofol anesthesia.These findings need to be further confirmed through prospective cohort studies and clinical trials.

关 键 词：预后营养指数 丙泊酚 结直肠癌 认知功能 

分 类 号：R735.3[医药卫生—肿瘤]