老年肺癌患者术后远期认知功能及其影响因素调查分析

A cross-sectional study on long-term postoperative cognitive function and influencing factors in older patients with lung cancer

目的:调查了解老年肺癌患者术后远期认知功能及影响因素,为提升其认知功能水平提供参考依据。方法:回顾研究2019年01月至2020年06月在空军军医大学第二附属医院行胸腔镜肺癌根治术的442例老年患者病历资料,并结合电话回访采集患者人口社会学特征信息和术后1~2年认知功能评分。采用t检验、χ^(2)检验或Fisher确切概率法进行单因素分析,通过多因素Logistic回归分析患者术后远期认知功能障碍的相关影响因素。结果:442例患者中89例出现认知功能障碍,发生率为20.14%。单因素分析结果显示认知功能障碍组和认知正常组患者的性别组成、文化程度、社会活动频率、独居生活和既往手术史以及术中麻醉药物、术后肺功能、睡眠质量和慢性痛发生情况存在显著差异(P<0.05)。多因素回归分析结果显示,患者文化程度较高和术中采取丙泊酚复合麻醉与其术后认知功能障碍的发生呈负相关,患者高龄、术后肺功能下降和出现慢性痛与其术后认知功能障碍的发生呈正相关。结论:老年肺癌患者术后1~2年的认知功能障碍发生率比较高,高文化程度和术中采用丙泊酚复合麻醉是其术后认知功能障碍发生的主要保护因素,肺功能下降、慢性疼痛和高龄是其主要危险因素。相关学科应通力合作,探索术中麻醉管理、术后防治慢性痛和肺功能下降的干预措施和医疗技术,以改善老年肺癌患者术后认知功能。

Objective:To explore the long-term cognitive function and influencing factors among older patients with lung cancer after surgery and offer some practical measures to improve their postoperative cognitive function.Methods:The clinical data of 442 older patients,who underwent thoracoscopic pulmonary resection at the Second Affiliated Hospital of Air Force Medical University between January 2019 and June 2020,were retrospectively analyzed.Their socio-demographic characteristics and scores of cognitive function were collected by telephone interview.The dependent-sample t-test,χ^(2) test and Fisher exact test were used for univariate analysis.Multivariate logistic regression analyses were used for identifying influencing factors for postoperative cognitive dysfunction(POCD).Results:The prevalence of POCD in this study was 20.14%(89/442),and the univariate analysis extracted related factors such as gender,education level,social activities,single life,surgical history,anesthetic,postoperative pulmonary function,sleep quality and chronic pain(P<0.05).In the logistic regression model,the higher education background and anesthesia combined with propofol were negatively associated with the incidence of POCD,while the pulmonary function decline,elder age and chronic pain were positively associated with it.Conclusion:From 1~2 years after surgery,the prevalence of POCD was high among older patients with lung cancer.The higher education background and anesthesia combined with propofol were extracted as protective factors for POCD,while pulmonary function decline,elder age,and chronic pain were risk factors.Relative departments should get together to explore the intervention measures and technologies,especially for anesthesia management and preventing chronic pain and pulmonary function decline which could improve their long-term cognitive function.