不同年龄全麻非心脏手术病人术后认知功能障碍的比较

Comparison of Postoperative Cognitive Dysfunction of Different Ages after Noncardiac Operation with General Anesthesia

目的探讨不同年龄组全麻非心脏手术病人术后认知功能障碍的发病情况及危险因素。方法择期手术病人90例,分3个年龄组,每组30例,group1(青年组):20～44岁,group2(中年组):45～59岁,group3(老年组):60岁以上,分别于术前、术后24h内,术后1周对病人进行神经心理学问卷测试,包括简易精神状态评价量表、数值广度试验(DSPT)顺向及逆向、数值符号试验(DSYT)、循环连线试验(TMT)、小故事记忆试验(SSMT)进行比较,每项试验与术前比较,大于2个标准差认为有意义,全部试验中大于2项有意义认定存在术后认知功能障碍。结果 3组病人术后第一天pocd发病率分别是13.3%、23.3%、36.7%,术后一周发病率分别是6.7%、10.0%、13.3%,3者比较,差异无统计学意义(P>0.05),ASA为术后第一天的危险因素,而ASA分级与低氧血症为术后一周的危险因素。结论 POCD的发生随年龄增加呈增多趋势,但差异无统计学意义,ASA为术后第一天的危险因素,而ASA分级与低氧血症为术后一周的危险因素。

Objective To compare the incidence of postoperative cognitive dysfunction （POCD） of different ages after noncardiac operation with general anesthesia and analyze the relative risk factors of the occurrence of POCD. Methods 90 inpatients were divided into 3 age groups, 30 patients in each group. Group1 was young group, aged from 20 to 44 years old; group 2 was middleaged group, aged from 45 to 59 years old and group 3, the elderly group, aged 60 years or older. All the patients were asked to finish the neuropsychological questionnaire test, which including MMSE, DSPT, DSYT, TMT, SSMT, preoperatively, 24h after the operation and 1 week after the operation respectively. The results of tests after the operation were compared with those before operation, more than 2 standard deviations were meaningful, and if a patient had more than 2 meaningful items in all the tests, then he or she would be diagnosed with POCD. Results The incidence of POCD of the three groups was 13.3%, 23.3% and 36.7% respectively 24h after the operation, and one week after the operation the incidence was respectively 6.7%, 10% and 13.3%. The data of the three groups were compared and P〈0.05; ASA was the risk factor of the occurrence of POCD 24h after the operation, while ASA grading and hypoxemia were the risk factors of the occurrence of POCD one week after the operation. Conclusion The old age group patients had higher morbidity of POCD post-operation than that of other two groups, but with no statistically significant difference. ASA was the risk factor of the occurrence of POCD 24h postoperation, while ASA grading and hypoxemia were the risk factors of the occurrence of POCD one week postoperation.