摘要
目的探讨腹腔镜结肠癌根治术老年患者术后早期认知功能障碍(POCD)的危险因素。方法选取2015年9月至2021年1月于西南医科大学附属医院和泸州市人民医院行腹腔镜结肠癌根治术的93例老年患者为研究对象,使用简易智力状态检查量表(MMSE)评估患者是否发生POCD,根据评估结果将患者分为POCD组(n=23)和非POCD组(n=70)。术中每5 min记录一次患者的血压,计算术中血压变异性(BPV)。测定患者术后24 h白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平,采用单因素分析和多因素Logistic回归分析明确POCD发生的危险因素。结果POCD组高龄(≥75岁)患者占比、术中BPV、术后24 h IL-6和TNF-α水平高于非POCD组(P<0.05);POCD组术前MMSE评分低于非POCD组(P<0.05)。Logistic相关性分析显示,与POCD发生相关的因素为:高龄(≥75岁)、术前低MMSE评分、术中平均动脉压(MAP)变异性增高。结论高龄(≥75岁)、术前低MMSE评分、术中MAP变异性增高的老年腹腔镜结肠癌根治术患者发生POCD的可能性更高,术中保持血压平稳能够减少POCD的发生。
Objective To investigate the risk factors for postoperative cognitive dysfunction(POCD)in elderly patients undergoing laparoscopic radical resection for colon cancer.Methods A total of 93 elderly patients who underwent laparoscopic radical resection for colon cancer at the Affiliated Hospital of Southwest Medical University and Luzhou People's Hospital from September 2015 to January 2021 were selected.POCD was measured by Minimum Mental State Examination(MMSE).The patients were divided into POCD group(n=23)and non-POCD group(n=70)according to MMSE scores.Intraoperative blood pressure was recorded every five minutes.Blood pressure variability(BPV)was calculated.Levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were determined at 24 h after operation.The risk factors for POCD were analyzed by univariate analysis and multivariate Logistic regression analysis.Results The proportion of patients with advanced age(≥75 years),intraoperative BPV,levels of TNF-αand IL-6 at 24 h after operation in POCD group were significantly higher than those in non-POCD group(P<0.05).Preoperative MMSE score in POCD group was significantly lower than that in non-POCD group(P<0.05).Multivariate Logistic regression analysis showed that the risk factors for POCD were advanced age(≥75),low preoperative MMSE score and increased intraoperative mean arterial pressure(MAP)variability.Conclusion Advanced age(≥75 years),low preoperative MMSE score,and increased intraoperative MAP variability are risk factors for POCD in elderly patients undergoing laparoscopic radical resection for colon cancer.Stable intraoperative blood pressure can reduce the incidence of POCD.
作者
章庆
陈卉
周述芝
钱厚霖
黄小玲
Zhang Qing;Chen Hui;Zhou Shuzhi;Qian Houlin;Huang Xiaoling(Department of Anesthesiology,Luzhou People's Hospital,Luzhou 646000,China;Department of Anesthesiology,Ya'an People's Hospital,Ya'an 625000,China;Department of Anesthesiology,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Anesthesiology,First People's Hospital of Longquanyi District,Chengdu 610100,China)
出处
《成都医学院学报》
CAS
2022年第5期583-586,591,共5页
Journal of Chengdu Medical College
基金
四川省医学会“四川省医学科研课题计划”项目(No:S18029)。
关键词
老年
术后认知功能障碍
血压变异性
炎性因子
Elderly
Postoperative cognitive dysfunction
Blood pressure variability
Inflammatory factor
