老年上腹部手术患者全麻术后认知功能障碍的发生因素

Incidence and influential factors of post-operative cognitive dysfunction in old patients with midsection surgery after general anesthesia

目的了解老年上腹部手术患者全麻术后认知功能障碍(POCD)的发生率及其危险测素。方法随机选择择期需要全身麻醉且年龄≥65岁的老年上腹部手术患者312例,美国麻醉医师协会病情分级Ⅰ～Ⅲ级。所有患者在术前、术后24、72 h由同一试验者采用简易智力状态检查法评估患者认知功能。全麻诱导用丙泊酚、芬太尼、维库溴铵。术中麻醉维持以间断静脉注射维库溴铵,持续静脉注射异丙酚和瑞芬太尼,并间断吸入异氟醚调整麻醉深度。结果 312例老年患者全麻术后有113例出现POCD,发生率为32.69%,随着年龄增加POCD发生率增加,POCD发病高峰期在术后24 h,高龄、合并高血压病和糖尿病、术后疼痛及受教育程度偏低的老年人群更容易引起POCD结论老年患者全麻术后POCD发病率较高,高龄、合并高血压病和糖尿病、术后疼痛,以及受教育程度偏低是引起老年人POCD的主要危险因素。

Objective To investigate the incidence and risk factors of post-operative cognitive dysfunction(POCD) in old patients with midsection surgery.Methods 312 patients were selected randomly from patients aged 65 or over,visual analogue scale/scoreⅠ～Ⅲ,and undergoing midsection surgery.The cognitive function of all patients was evaluated by mini-mental state examination pre-operation,24 h and 72 h post-operation by the same researcher.Results 113 cases suffered POCD,and the incidence rate was 32.69%.The peak time of POCD was 24 hour post-operation.The incidence rate of POCD was increased with the age.The older patients, hypertension,diabetes,pain and poor education increased the possibility of POCD.Conclusion A higher incidence rate of POCD appeared in old patients after general anesthesia.The main influential factors may be age,hypertension,diabetes,pain and poor education.