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| 老年患者胃肠肿瘤手术后认知功能障碍的相关因素 |
| Related factors of postoperative cognitive dysfunction in elderly patients undergoing gastrointestinal cancer surgery |
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| DOI：10.12089/jca.2022.06.011 |
| 中文关键词: 术后认知功能障碍 老年 胃肠肿瘤手术 相关因素 Narcotrend指数 局部脑氧饱和度 |
| 英文关键词: Postoperative cognitive dysfunction Aged Gastrointestinal cancer surgery Related factors Narcotrend index Regional cerebral oxygern saturation |
| 基金项目: |
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| 中文摘要: |
目的 探讨胃肠肿瘤手术老年患者术后认知功能障碍（POCD）的相关因素。
方法 收集201例胃肠肿瘤手术老年患者的临床资料，男106例，女95例，年龄≥65岁。根据患者是否发生POCD分为两组：POCD组和非POCD组。采用Logistic回归分析POCD的相关因素。采用受试者工作特征（ROC）曲线分析独立危险因素对老年患者胃肠肿瘤手术POCD的预测价值。
结果 共有67例（33.3%）患者发生POCD。POCD组BMI明显低于非POCD组，全麻联合硬膜外阻滞比例、右美托咪定预防性用药比例明显低于非POCD组，术中NTI＜35时间、术中ΔrSO2＞13%时间明显长于非POCD组（P＜0.05）。多因素Logistic回归分析结果显示，全麻联合硬膜外阻滞（OR=0.280，95%CI 0.097～0.809,P＜0.05）、右美托咪定预防性用药（OR=0.276，95%CI 0.096～0.799，P＜0.05）是老年患者胃肠肿瘤手术POCD的保护因素，术中NTI＜35时间延长（每延长1 min，OR=1.213，95%CI 1.131～1.301，P＜0.05）和ΔrSO2＞13%时间延长（每延长1 min，OR=1.174，95%CI 1.102～1.252，P＜0.05）是老年患者胃肠肿瘤手术POCD的独立危险因素。术中NTI＜35时间、术中ΔrSO2＞13%时间及二者联合预测POCD的ROC曲线下面积（AUC）分别为0.856、0.843和0.929，差异无统计学意义。
结论 全麻联合硬膜外阻滞、右美托咪定预防性用药是老年患者胃肠肿瘤手术POCD的保护因素，长时间的术中NTI＜35和ΔrSO2＞13%是POCD的独立危险因素，术中NTI＜35时间和术中ΔrSO2＞13%时间预测胃肠肿瘤手术老年患者POCD均具有较高的临床价值。 |
| 英文摘要: |
Objective To explore related factors of postoperative cognitive dysfunction (POCD) in elderly patients undergoing gastrointestinal cancer surgery.
Methods A total of 201 elderly patients with gastrointestinal cancer were collected, 106 males and 95 males, aged ≥ 65 years. Data were collected and those patients were divided into POCD group and non-POCD group according to whether POCD occured. Differences of data were compared between the two groups. Logistic regression was used to analyze the related factors. Receiver operating curve (ROC) was used to analyze the predictive value of independent risk factors.
Results POCD occurred in 67 patients (33.3%). BMI, proportion of general anesthesia combined with epidural anesthesia and preemptive analgesia of dexmedetomidine in the POCD group were lower than those in the non-POCD group, while intraoperative time of NTI < 35 and ΔrSO2> 13% in the POCD group were longer than those in the non-POCD group (P < 0.05). Multivariate logistic regression analysis showed that general anesthesia combined with epidural anesthesia (OR = 0.280, 95% CI 0.097-0.809, P < 0.05) and preemptive analgesia of dexmedetomidine (OR = 0.276, 95% CI 0.096-0.799, P < 0.05) were protective factors of POCD in elderly patients undergoing gastrointestinal cancer surgery, while the time of intraoperative NTI < 35 prolonged(for every one minute prolonged, OR = 1.213, 95% CI 1.131-1.301, P < 0.05), and the time of ΔrSO2> 13% prolonged (for every one minute prolonged, OR = 1.174, 95% CI 1.102-1.252, P < 0.05) were independent risk factors of POCD. The area under ROC curve (AUC) of the intraoperative time of NTI < 35, the time of ΔrSO2> 13%, and the combined indices in predicting on POCD were 0.856, 0.843, and 0.929, respectively. There were no significant differences between the AUC of combined indices and single intraoperative time of NTI < 35 or ΔrSO2> 13%.
Conclusion General anesthesia combined with epidural anesthesia and preemptive analgesia of dexmedetomidine are protective factors of POCD in elderly patients undergoing gastrointestinal cancer sugery, while the time of intraoperative NTI < 35 or ΔrSO2> 13% prolonged is independent risk factor of POCD. Intraoperative time of NTI < 35 or ΔrSO2> 13% has high clinical value in predicting POCD in elderly patients undergoing gastrointestinal cancer surgery. |
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