腹腔镜广泛性子宫切除术患者术后认知功能障碍的危险因素与护理对策

Risk factors analysis for postoperative cognitive dysfunction and nursing intervention in patients undergoing laparoscopic radical hysterectomy

目的 筛选腹腔镜广泛性子宫切除术患者术后认知功能障碍（POCD）的危险因素,并探讨相应的护理对策.方法 择期行腹腔镜广泛性子宫切除术患者100例,记录患者手术史、全身麻醉方式、患者受教育年限、患者家庭因素（是否独居）、体质量指数、年龄、麻醉时间、舒芬太尼用量、术后红细胞压积、定向力恢复时间、麻醉复苏期躁动情况、术后疼痛程度.术后7d（早期）和术后3个月（远期）记录POCD发生情况.将组间差异有统计学意义的因素进行Logistic回归分析,筛选POCD的危险因素.结果 早期POCD发生率为29.0%（29/100）;以患者的手术史、体质量指数、年龄、全身麻醉方式、术后红细胞压积、定向力恢复时间、术后疼痛程度为协变量进行Logistic回归分析显示,全身麻醉方式（OR=2.821,95%CI1.099~7.240）、术后疼痛程度（OR=2.292,95%CI1.129~4.654）为腹腔镜广泛性子宫切除术患者早期POCD的危险因素.远期POCD发生率为7.0%（7/100）;以患者的受教育年限和患者家庭因素（是否独居）为协变量进行Logistic回归分析显示,患者家庭因素（是否独居）是腹腔镜广泛性子宫切除术患者远期POCD的危险因素（OR=5.517,95%CI1.010~30.126）.结论 腹腔镜广泛性子宫切除术患者早期POCD的危险因素为全身麻醉方式和术后疼痛程度,远期POCD的危险因素为家庭因素（是否独居）,针对危险因素提出相应的护理对策.

Objective To investigate the risk factors for postoperative cognitive dysfunction （POCD） and nursing intervention in patients undergoing laparoscopic radical hysterectomy. Methods One hundred patients undergoing laparoscopic radical hysterectomy were included, surgical history, general anesthetics way, education, family factors（alone）, body mass index, age, duration of anesthesia, dose of sufentanyl, hematocrit, the time for regaining orientation, dysphoria, postoperative pain degree were recorded. The occurrence of POCD was observed at 7 days （early period） and 3 months （later period） after surgery. Logistic regression analysis was used to examine the risk factors for POCD at early period and later period. Results The incidence of POCD at early period was 29.0%（29/100）. Logistic regression analysis of surgical history, general anesthetics way, body mass index, age, hematocrit, the time for regaining orientation, postoperative pain degree in patients, general anesthetics way （OR=2.821, 95%CI 1.099-7.240） and postoperative pain degree（OR=2.292, 95%CI 1.129-4.654） were the significant risk factors for POCD at early period. The incidence of POCD at later period was 7.0%（7/100）. Logistic regression analysis of education and family factors（alone） in patients, family factors（alone） was the significant risk factor for POCD at later period （OR=5.517, 95%CI 1.010-30.126）. Conclusions General anesthetics way and postoperative pain degree are the significant predictors for POCD in patients undergoing laparoscopic radical hysterectomy during hospitalization, and family factors（alone） is the risk factor for POCD at 3 months after surgery, and active nursing intervention could reduce the occurrence of POCD.