经尿道前列腺电切术后并发认知功能障碍的高危因素分析

Study of risk factors about complication of POCD during TURP

目的:研究经尿道前列腺电切(transurethral resection of prostate,TURP)术后并发认知功能障碍(post-operation cognitive dysfunction,POCD)的高危因素和防治方法。方法:收集2005年7月～2009年11月TURP病例1052例,回顾性分析发生POCD病例66例。评价指标:年龄,国际前列腺症状评分(IPSS),体质指数(BMI),有否心肺合并症,美国麻醉学会(ASA)评分,前列腺体积,平均手术时间,麻醉方式(全麻,硬膜外麻醉),围手术期是否输血,短期是否二次手术,有否精神类疾病或其药物史。采用卡方检验和非条件Logistic回归多因素分析。结果:高龄(>73岁),IPSS>26分,ASAⅡ级以上,前列腺体积(重量≥40g),手术时间≥46min,有合并心肺疾病,有精神相关疾病和服相关药物史,麻醉方式为全麻,和急需短期二次手术等有统计学意义(P<0.05)。BMI,围手术期是否输血无统计学意义(P>0.05)。多因素Logistic回归分析(β,OR值,P值):麻醉方式(2.234,7.082,0.000),有精神类疾病或其服药史(2.012,5.314,0.001),年龄(1.473,2.426,0.012),ASA评分(0.685,3.403,0.003),手术时间(0.538,2.005,0.019)有统计学意义(P<0.05)。结论:TURP术后并发POCD的高危因素包括高龄、ASA分级、手术时间、麻醉方式(全麻)、有无精神相关疾病或其服药史(P<0.05)。POCD相关因素筛选有助于提高早期诊断率,及时处理,防止继发其他并发症发生。

Objective：To study the risk factors and prevention measurements of complication of post-operation cognitive dysfunction（POCD）during transurethral resection of prostate（TURP）.Methods：1 052 benign prostate hyperplasia（BPH） patients received TURP were retrospectively collected from 2005.7 to 2009.11,including 66 cases diagnosed of POCD.There were 11 evaluation indexes including of age,IPSS score,BMI,cardiopulmonary comorbidities,ASA score,volume of prostate,average operation time,anaesthesia way,transfusion in per-operation or not,second operation or not in short term,suffering psychosis or overdose or not.All above were analyzed with Chi-square test for mono-factor and two dimensional logistic regression analysis for multi-factor.Results：Chi-square test found that age over 73 years,IPSS score over 26,ASA score over Ⅱ,volume of prostate over 40 gram,average operational time over 46 min,comorbidities of cardiopulmonary,anaesthesia way,suffering psychosis or overdose and second operation in short term were significantly related to POCD（P0.05）except for other factors of BMI and transfusion in per-operation or not.Logistic regression found age over 73 years,ASA score over II,comorbidities of cardiopulmonary,anaesthesia way and suffering psychosis or overdose were significantly related to POCD（P0.05）.Conclusion：Risk factors of POCD during TURP included age over 73 years,ASA rank score over II,comorbidities of cardiopulmonary,anaesthesia way（general anaesthesia）and suffering psychosis or overdose.Screen of the risk factors related to POCD will be useful for early diagnosis of POCD and prevention of other complication.