摘要
目的有关老年患者术前脑功能评价的意义尚未明确。文中探讨老年患者术前认知功能损害与术后死亡率及并发症发病率的关系。方法回顾性分析2015年5月至2016年5月东部战区总医院181例年龄&65岁,ASA分级I〜IE级行择期手术老年患者的临床资料。根据简易智能量表(MMSE)评分将患者分为术前认知功能损害组和术前认知功能正常对照组。比较两组患者术后的死亡率及并发症发病率差异。先通过组间单因素分析筛选出死亡率增加的可能危险因素,然后经Logistic回归分析确定患者死亡的独立危险因素。比较两组患者术后1年电话随访生活质量量表(SF-36)结果。结果本研究纳人181例患者,其中23例患者(12.7%)伴有术前有认知功能损害,术前认知功能损害组术后生活质量降低,术后并发症与死亡率增加(P<0.05)。与认知功能正常组相比,术前认知功能损害组中年龄、脑卒中与糖尿病发生率显著增加,体重显著降低(P<0.05)。经多因素分析显示老年患者术前低MMSE评分(OR=0.875,95%CI:0.795~0.963,P=0.006)、高龄(0R=1.134,95%CI:1.048~l.227,P=0.002)是老年患者术后5年病死率的独立危险因素。结论老年患者术前认知功能损害可显著降低患者术后生活质量,增加术后并发症和远期死亡率的发生率。
Objective The significance of preoperative evaluation of brain function in elderly patients remains unclear.The relationship between preoperative cognitive impairment and postoperative mortality and morbidity of complications in elderly patients was investigated.Methods A retrospective analysis was performed on the clinical data of 181 elderly patients aged^65 years and ASA grade I-IH who underwent elective surgery in General Hospital of Eastern Theater Command from May 2015 to May 2016.Patients were divided into preoperative cognitive impairment group and normal control group according to MMSE score.The postoperative mortality and morbidity of complications were compared between the two groups.Possible risk factors for increased mortality were screened by monofactor analysis between groups,and independent risk factors for death were determined by Logistic regression analysis.The results of the quality of life scale(SF 36)were compared between the two groups through telephone follow-up one year after the surgery.Results A total of 181 patients were included in this study,of whom 23 patients(12.7%)had preoperative cognitive impairment.The preoperative cognitive impairment group had lower postoperative quality of life.The preoperative cognitive impairment group had lower postoperative quality of life,higher postoperative complications and mortality(P<0.05).Compared with the normal control group,the incidence of age,stroke,and diabetes were significantly increased and body weight significantly decreased in preoperative cognitive impairment group(P<0.05).Multivariate analysis showed that low preoperative MMSE score(OR=0.875,95%Cl:0.795-0.963,P=0.006)and old age(0R=1.134,95%CI:1.048-1.227,P=0.002)were independent risk factors for mortality in elderly patients 5 years after surgery.Conclusion Preoperative cognitive impairment in elderly patients can significantly reduce postoperative quality of life and increase the incidence of postoperative complications and longterm mortality.
作者
高炟鹏
李丽萍
张利东
周志强
嵇晴
GAO Da-peng;LI Li-ping;ZHANG Li-dong;ZHOU Zhi-qiang;JI Qing(Department of Anesthesiology,Jinling Hospital,Nanjing University School of Medicine/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)
出处
《医学研究生学报》
CAS
北大核心
2021年第12期1273-1276,共4页
Journal of Medical Postgraduates
基金
国家自然科学基金(81571083)。
关键词
老年患者
术前认知功能损害
死亡率
并发症
elderly
preoperative cognitive impairment
mortality
complications
