老年患者全麻下行腹腔镜胆囊切除术后早期认知功能的评估

Evaluation of postoperative cognitive dysfunction in old patients with laparoscopic cholecystectomy under general anesthesia

【目的】探讨我院老年患者行腹腔镜胆囊切除术后早期认知功能的发生情况以及相关危险因素分析。【方法】选择260例在我院拟气管插管全麻下择期行腹腔镜胆囊切除术的老年患者,于手术前1 d、手术后1、3、5 d分别进行简易智力状态检测评分(mini-mental state examination score,MMSE),根据MMSE分值的变化来评价手术前后认知功能的发生情况,并分析导致老年LC患者POCD的相关危险因素。【结果】260例老年患者LC术后POCD术后1d发生率为8.85%,术后3d发生率为5.38%,术后5d发生率1.15%。POCD组与非POCD组术前MMSE评分比较差异无统计学意义。POCD组术后1、3 d较术前明显下降,差异有统计学意义(P<0.05),术后5 d基本恢复至术前水平(P>0.05)。其中高龄、合并高血压和糖尿病以及受教育偏低患者成为导致老年患者POCD的相关危险因素(P<0.05)。【结论】高龄、合并高血压和糖尿病、受教育偏低是引起老年人LC术后POCD的主要危险因素。

[ Objective ] To analyze the morbidity and related factor influencing postoperative cognitive disorder （POCD） in elder patients underwent laparoscopic chotecystectomy. [ Methods ] 260 cases elderly patients in our hospital undergoing laparoscopic operation were selected, Mini-mental state examination score （MMSE） was conducted respectively at the time of ld preoperative,1 d, 3 d, 5 d postoperative. According to MMSE score changes to evaluate cognitive dysfunction preoperative and postoperative and analysis of related risk factors of POCD in elderly patients with LC. [Results] The morbidity of POCD of ld, 3d,5d postoperative was 8.85%, 5.38%, 1.15% in 260 cases of elderly patients after LC. There was no significant difference in MMSE score between POCD groups and non-POCD groups of preoperative. The morbidity of POCD decreased significantly in 1 d, 3 d postoperative compared with preoperative values, there was statistically significant （P 〈 0.05）, 5 d postoperative returned to the preoperative levels （P 〉 0.05）. The older patients, hypertension, diabetes and poor education increased influential factors of POCD （P 〈 0.05）. [Conclusion] Age, hypertension and diabetes, education became the main influential factors of POCD in elder patients underwent LC.