摘要
目的探究老年结肠癌患者腹腔镜术后认知功能障碍(POCD)发生的危险因素。方法选取2016年1月~2018年12月哈尔滨医科大学附属第一医院接受腹腔镜手术治疗的老年结肠癌患者300例作为研究对象。根据是否发生POCD分为POCD组(62例)和非POCD组(238例)。比较两组基本资料及手术指标,采用多因素logistic回归分析老年结肠癌患者腹腔镜POCD危险因素。结果POCD组年龄、术前简易智力状态检查量表(MMSE)评分和高血压、糖尿病发生率均高于非POCD组,受教育年限低于非POCD组(P<0.05)。POCD组麻醉时间、术中出血量、术后视觉模拟评分(VAS)及苏醒期躁动例数占比均高于非POCD组,术后血红蛋白和术前使用右美托咪啶例数、术后硬膜外自控镇痛(PCEA)例数占比均低于非POCD组(P<0.05)。多因素logistic回归分析年龄、高血压、糖尿病、术前MMSE评分、麻醉时间、术中出血量、术后VAS评分、苏醒期躁动均是老年结肠癌患者腹腔镜POCD发生的独立危险因素(P<0.05),受教育年限、术后血红蛋白增加、术前使用右美托咪啶、术后PCEA是老年结肠癌患者腹腔镜POCD发生的保护性因素(P<0.05)。结论年龄、术前MMSE评分、麻醉时间、术中出血量、术后VAS评分的增加以及高血压、糖尿病、苏醒期躁动的发生使老年结肠癌患者腹腔镜POCD发生的风险增加,随着受教育年限、术后血红蛋白的增加以及术前使用右美托咪啶、术后PCEA,POCD的发生风险随之降低。
Objective To explore the risk factors for postoperative cognitive dysfunction( POCD) in older patients undergoing laparoscopic surgery for colon cancer. Methods A total of 300 older patients with colon cancer who received laparoscopic surgery were selected in the First Affiliated Hospital of Harbin Medical University from January 2016 to December 2018. According to the occurrence of POCD,the patients were divided into POCD group( 62 cases) and non-POCD group( 238 cases). The basic data and surgical indexes of the two groups were compared. The risk factors for POCD were analyzed by multivariate logistic regression.Results The age,mini-mental state examination( MMSE) score,incidence of hypertension and diabetes in POCD group were higher than those in non-POCD group,and the education level in POCD group was lower than that in non-POCD group( P <0. 05). The anesthesia time,intraoperative blood loss,postoperative visual analog score( VAS) and the number of cases with agitation in recovery period in POCD group were higher than those in non-POCD group,the level of postoperative hemoglobin,the preoperative use of dexmedetomidine and postoperative use of patient-controlled epidural analgesia( PCEA) were lower than those in non-POCD group( P < 0. 05). Multivariate logistic regression analysis showed that the age,hypertension,diabetes,preoperative MMSE score,anesthesia time,intraoperative blood loss,postoperative VAS score,and agitation during recovery were the independent risk factors for POCD( P < 0. 05). The education level,postoperative level of hemoglobin,preoperative use of dexmedetomidine and postoperative use of PCEA were the protective factors for POCD( P < 0. 05). Conclusion In older patients undergoing laparoscopic surgery for colon cancer,the increase of age,preoperative MMSE score,anesthesia time,intraoperative blood loss,postoperative VAS score,and hypertension,diabetes,agitation during recovery increased the risk for POCD. The increase of education level and postoperative hemoglobin level,preoperative use of
作者
张婷
郑宏群
邱丽娜
Zhang Ting;Zheng Hongqun;Qiu Lina(Department of Critical Care,the First Affiliated Hospital of Harbin Medical University,Harbin 150000;Department of General Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150005)
出处
《国际老年医学杂志》
2021年第4期220-223,共4页
International Journal of Geriatrics
基金
黑龙江省青年科学基金(QC2012C019)。
关键词
结肠癌
腹腔镜
术后认知功能障碍
危险因素
Colon cancer
Laparoscopic surgery
Postoperative cognitive dysfunction
Risk factors
