老年患者术后认知功能障碍的危险因素

Risk factors for .postoperative cognitive dysfunction in elderly patients

目的筛选老年患者发生术后认知功能障碍（POCD）的危险因素。方法择期手术患者240例，ASAⅠ或Ⅱ级，年龄65～86岁，根据麻醉方法不同分为3组（n=80）：全身麻醉组（G组）、硬膜外阻滞组（E组）和局部麻醉组（L组）。分别于术前1d、术后1、3、5d记录MMSE评分，计算术前MMSE评分的标准差，每例患者术后MMSE评分与术前MMSE评分比较≥1个标准差时即发生POCD。将不同年龄、性别、文化程度、麻醉方法、手术时间和术前MMSE评分的老年患者POCD发生率进行比较，若差异有统计学意义，该因素进入非条件logistic回归模型，筛选老年患者发生POCD的危险因素。结果性别、文化程度、麻醉类型、手术时间≥90min及术前MMSE评分〈23分不是老年患者POCD发生的危险因素；年龄≥75岁与老年患者POCD的发生有关（P〈0．05）。结论年龄≥75岁是老年患者发生POCD的危险因素。

Objective To investigate the risk factors for postoperative cognitive dysfunction （POCD） in elderly patients. Methods Two hundred and forty ASA Ⅰ or Ⅱ patients without mental or neurological deficit, aged 65-86 yr undergoing elective surgery were divided into 3 groups （ n = 80 each） ： group Ⅰ general anesthesia （G）; group Ⅱ epidural anesthesia （E） and group Ⅲ local anesthesia （L）. The types of surgery included abdominal, orthopedic and ophthalmic operations. The cognitive function of the patients was assessed at day 1 before and days 1, 3, or 5 after operation using Mini-Mental State examination （MMSE）. Diagnostic criterion of POCD was defined as a decline in score more than or equal to the preoperative standard deviation in all patients. After the comparison of the influence of these factors, such as different ages, gender, educational levels, anesthesia methods, operation time and preoperative MMSE score, on incidence of POCD in elderly patients, if there was significant difference, the factors were analyzed using unconditional logistic regression to select the risk factors for incidence of POCD in elderly patients. Results The factors, such as gender, educational levels, anesthesia type, operation time /〉 90 min and preoperative MMSE score 〈 23, were not the risk ones for incidence of POCD in elderly patients. The factor of age≥ 75 yr was related to the incidence of POCD in elderly patients. Conclusion Age≥ 75 yr is the only significant independent risk factor for POCD in elderly patients.