老年病人结直肠癌根治术后早期认知功能障碍的危险因素分析
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摘要
目的分析老年病人结直肠癌根治术后发生早期认知功能障碍的危险因素。方法 80例接受全身麻醉下结直肠手术的老年病人纳入研究,术前1 d和术后第7天进行认知功能评定,根据"Z"计分法判定是否发生术后认知功能障碍(POCD),采用Logistic多元逐步回归分析POCD危险因素。结果 19例病人被判定为POCD (24.7%)。Logistic多元逐步回归分析显示,糖尿病史(OR=8.391,95%CI:2.208~31.882),术后禁食时间≥3 d(OR=5.236,95%CI:1.998~13.721),术后第2天全身炎症反应(SIRS)评分≥3分(OR=6.995,95%CI:1.948~25.111)是老年结直肠根治术后早期POCD的危险因素。结论糖尿病史、术后禁食时间≥3 d以及术后第2天SIRS评分≥3分对老年病人结直肠术后发生早期POCD产生影响。
Objective To investigate the risk factors of early postoperative cognitive dysfunction(POCD) in the elderly patients receiving radical resection for colorectal cancer.Methods Eighty elderly patients who received radical resection for colorectal cancer under general anesthesia were enrolled.Neuropsychological tests were performed preoperatively and at the seventh day after operation.The risk factors for POCD were analyzed using a multivariate Logistic regression model.Results Nineteen patients were diagnosed as POCD(24.7%).Diabetes history(OR=8.391,95% CI:2.208-31.882),fasting over three days after surgery(OR=5.236,95%CI:1.998-13.721) and SIRS score>3 on the second day after surgery(OR=6.995,95%CI:1.948-25.111) were risk factors of early POCD in the elderly patients after radical resection for colorectal cancer.Conclusions The risk factors for early POCD after radical resection of colorectal cancer in the elderly patients include diabetes history,fasting over three days,and SIRS score>3 on the second day.
Objective To investigate the risk factors of early postoperative cognitive dysfunction(POCD) in the elderly patients receiving radical resection for colorectal cancer.Methods Eighty elderly patients who received radical resection for colorectal cancer under general anesthesia were enrolled.Neuropsychological tests were performed preoperatively and at the seventh day after operation.The risk factors for POCD were analyzed using a multivariate Logistic regression model.Results Nineteen patients were diagnosed as POCD(24.7%).Diabetes history(OR=8.391,95% CI:2.208-31.882),fasting over three days after surgery(OR=5.236,95%CI:1.998-13.721) and SIRS score>3 on the second day after surgery(OR=6.995,95%CI:1.948-25.111) were risk factors of early POCD in the elderly patients after radical resection for colorectal cancer.Conclusions The risk factors for early POCD after radical resection of colorectal cancer in the elderly patients include diabetes history,fasting over three days,and SIRS score>3 on the second day.
引文
[1]王杰,何震宇.老年结直肠癌患者腹腔镜与开放手术应激反应的临床对比研究[J].实用老年医学,2014,28(11):934-936.
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[2]Papamichael D,Audisio RA,Glimelius B,et al.Treatment of colorectal cancer in older patients:International Society of Geriatric Oncology(SIOG)consensus recommendations2013[J].Ann Oncol,2015,26(3):463-476.
[3]Moller JT,Cluitmans P,Rasmussen LS,et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1study.ISPOCD investigators.International Study of Post-Operative Cognitive Dysfunction[J].Lancet,1998,351(9106):857-861.
[4]付征,张韫辉,张惠军,等.乌司他丁对纵隔肿瘤切除患者术后认知功能的影响[J].实用老年医学,2016,30(7):556-558.
[5]Tachibana S,Hayase T,Osuda M,et al.Recovery of postoperative cognitive function in elderly patients after a long duration of desflurane anesthesia:a pilot study[J].JAnesth,2015,29(4):627-630.
[6]Sun S,Sun D,Yang L,et al.Dose-dependent effects of intravenous methoxamine infusion during hip-joint replacement surgery on postoperative cognitive dysfunction and blood TNF-alpha level in elderly patients:a randomized controlled trial[J].BMC Anesthesiol,2017,17(1):75-77.
[7]王建平.中国《结直肠癌诊疗规范(2010版)》解读[J].中华胃肠外科杂志,2011,14(1):1671-1674.
[8]Di Mondi VP,Townsend ML,Drew RH.Risk factors associated with unfavorable short-term treatment outcome in patients with documented Pseudomonas aeruginosa infection[J].Int J Clin Pharm,2015,37(2):348-354.