术前“位置法”记忆训练对全麻下开腹术老年病人术后早期认知功能的影响

Effect of memory training using the ＂method of loci＂ before operation on early postoperative cognitive function in elderly patients undergoing laparotomy under general anesthesia

目的 评价术前“位置法”记忆训练对全麻下开腹术老年病人术后早期认知功能的影响.方法 择期全麻下开腹术病人96例,年龄≥60岁,BMI 16～ 31 kg/m2,ASA分级Ⅱ或Ⅲ级,性别不限.采用随机数字表法,将其分为2组：对照组（C组,n=49）和记忆训练组（T组,n=47）.T组于术前3d开始行“位置法”记忆训练,1次/d,至术前1d,每次30 ～ 40 min.分别于记忆训练前和术后7d时进行神经心理学测试,记录术后认知功能障碍（POCD）的发生情况.根据是否发生POCD,将病人分为非POCD组和POCD组,将非POCD组与POCD组间差异有统计学意义的因素进行logistic多元回归分析,筛选POCD的危险因素.结果 C组和T组POCD发生率分别为36％（16例）和16％（7例）,T组低于C组（P＜0.05）.与非POCD组比较,POCD组年龄较高,术前接受记忆训练比率降低（P＜0.05）.logistic回归分析结果显示：高龄和术前未接受记忆训练是POCD的危险因素（P＜0.05）.结论 术前“位置法”记忆训练可改善全麻下开腹术老年病人术后早期认知功能.

Objective To evaluate the effect of memory training using the ＂method of loci＂ before operation on the early postoperative cognitive function in the elderly patients undergoing laparotomy under general anesthesia.Methods Ninety-six ASA physical status Ⅱ or Ⅲ patients of both sexes,aged ≥60 yr,with body mass index 16-31 kg/m2,scheduled for elective laparotomy under general anesthesia,were randomly divided into 2 groups using a random number table：control group （group C,n =49） and memory training group （group T,n =47）.The patients in T group received the memory training using the ＂method of loci＂ once a day （about 30-40 min for each time） starting from 3 days before operation until 1 day before operation.Neuropsychological tests were performed before training and on 7 days after operation.The development of postoperative cognitive dysfunction （POCD） was recorded.The patients were divided into POCD group and non-POCD group depending on whether or not POCD occurred.The risk factors of which P values were less than 0.05 between POCD group and non-POCD group would enter the logistic regression analysis to stratify POCD-related risk factors.Results The incidence of POCD was 36% （16 cases） and 16% （7 cases） in C and T groups,respectively.The incidence of POCD was significantly lower in group T than in group C.Compared with non-POCD group,the age was significantly older and the ratio of patients who received memory training before operation was decreased in POCD group.Logistic regression analysis showed that old age and no preoperative memory training were risk factors for POCD.Conclusion Memory training using the ＂method of loci＂ before operation can improve the early postoperative cognitive function in the elderly patients undergoing laparotomy under general anesthesia.