少年儿童非心脏手术术后认知功能障碍发生率调查及危险因素分析

Incidence and risk factors of postoperative cognitive dysfunction after non-cardiac surgery in children and juvenile

目的研究少年儿童非心脏手术术后认知功能障碍（postoperative cognitive dysfunction，POCD）的发生率，并分析其相关危险因素。方法采用简单随机化法选择择期非心脏手术4岁～16岁患者110例作手术组，同年龄段健康受试者50例作对照组。记录出生方式、受教育程度、既往手术史及术后并发症；术后1d-3d随访并发症情况。两组受试者分别于术前1d、术后3d采用“韦氏幼儿智力量表”或“韦氏儿童智力量表修订版”进行神经心理学测试。按Z计分法计算POCD的发生率。采用多因素Logistic回归分析POCD的危险因素。结果手术组100例，对照组43例完成研究。手术组术后3dPOCD的发生率是15．0％，对照组为2．3％，差异有统计学意义（P〈0．05）；Logistic回归分析结果显示：既往麻醉手术史与术后感染为少年儿童非心脏手术后POCD的独立危险因素（P〈0．05）。结论少年儿童非心脏手术后POCD发生率为15．0％，既往麻醉手术史与术后感染是发生POCD的独立危险因素。

Objective To investigate the incidence and risk factors of postoperative cognitive dysfunction （POCD） in children and juvenile after non-cardiac surgery. Methods 110 patients undergoing elective non-cardiac surgery aged between 4 y- 16 y, ASA Ⅰ -Ⅱ , were collected as operation group, and 50 healthy age-matched children were collected as control group. Children＇ s childbirth, education, history of operation with anesthesia, and complication of surgical patients were recorded. Neuropsychological tests （wechsler preschool and primary scale of intelligence or wechsler intelligence scale for children-revised） were completed 1 d before and 3 d after surgery. POCD was calculated as a combined Z-score. Multivariate logistic regression analyses were used to identify independent risk factors of POCD. Results 100 in operation group and 43 in control group completed the study. POCD was confirmed in 15/100 （15.0%） in operation group compared with 1/43 （2.3%） in control group 3 d after surgery. Logistic regression analysis revealed that the history of operation and postoperative infection were independent risk factors of POCD. Conclusions The occurrence rate of POCD after non-cardiac surgery in children and juvenile is 15.0%. Children and juvenile who had some exposure to operation before and postoperative infection are more prone to develop POCD.