术前认知功能障碍对老年患者经胃镜胃黏膜下肿瘤切除术后谵妄的影响

Effect of preoperative cognitive dysfunction on delirium after gastroscopic submucosal tumor resection in elderly patients

目的观察在经胃镜胃黏膜下肿瘤切除术中,合并术前认知障碍对老年患者术后谵妄(POD)的影响。方法选取宁波市第九医院2019年1—4月期间接受经胃镜胃黏膜下肿瘤切除术的老年患者56例,术前采用简易精神状态评价量表(MMSE)进行认知功能评估,并根据是否合并认知功能障碍将患者分为术前认知功能障碍组(研究组)和健康组(对照组),每组各28例,两组患者的麻醉及手术方法完全一致。术前1 d(T1)、术后第1天(T2)、术后第2天(T3)、术后第3天(T4),分别检测外周血高敏C反应蛋白(hs-CRP)水平。T2、T3、T4时点采用谵妄分级量表(DRS)评价患者DRS严重程度分及POD发生率。结果相比于T1时点,两组患者T2、T3、T4时点hs-CRP水平均显著升高(P<0.05);但两组患者T1~T4时点hs-CRP水平比较,差异无统计学意义(P>0.05)。与对照组比较,研究组患者T2、T3、T4时点DRS严重程度评分明显升高,T2、T3时点POD发生率升高(P<0.05)。结论在经胃镜胃黏膜下肿瘤切除术中,合并术前认知功能障碍的老年患者术后谵妄发生率明显升高,且更加严重。

Objective To observe the effects of preoperative cognitive dysfunction on postoperative delirium(POD)in elderly patients after gastroscopic submucosal tumor resection.Methods A total of 56 elderly patients who underwent gastroscopic submucosal tumor resection in Ningbo Ninth Hospital from January to April 2019 were selected as research subjects.Preoperative cognitive function was evaluated using Minimum Mental State Examination(MMSE),and the patients were divided into two groups according to whether they had cognitive dysfunction:preoperative cognitive dysfunction group(study group)and healthy group(control group),with 28 patients in each group.The patients in both groups were given same anesthesia and surgical methods.The level of high-sensitivity C-reactive protein(hs-CRP)in peripheral blood was measured 1 day before surgery(T1),1 day after surgery(T2),2 days after surgery(T3),and 3 days after surgery(T4).The severity of postoperative delirium and the incidence of POD were evaluated by delirium rating scale(DRS)at T2,T3 and T4.Results Compared with T1,the hs-CRP levels in both groups at T2,T3,and T4 were significantly increased(P<0.05).However,there was no significant difference in the hs-CRP levels between the two groups at T1-T4(P>0.05).Compared with the control group,the severity of DRS in the study group was significantly increased at T2,T3 and T4,and the incidence of POD was significantly increased at T2 and T3(P<0.05).Conclusion The incidence of postoperative delirium increases significantly and the postoperative delirium is more serious in elderly patients with preoperative cognitive dysfunction during gastroscopic submucosal tumor resection.