老年患者术后认知功能障碍发生情况及相关因素研究

Incidence and related factors of postoperative cognitive dysfunction in elderly patients

目的探讨老年患者术后认知功能障碍(POCD)发生情况及相关影响因素。方法选择2015年1月至2016年6月期间我院收治的400例老年择期手术患者,采用简易智力量表(MMSE)评分,术后下降≥4分判断为发生POCD,调查术后POCD的发生率,根据是否发生POCD将患者分为POCD组、非POCD组,比较两组患者临床资料。结果本组400例患者中术后发生POCD 63例,发生率为15.75%;POCD组患者受教育年限为(3.2±1.2)年,短于非POCD组的(4.1±1.7)年,高血压、全麻比例,麻醉时间>200 min者比例分别为46.03%(29/63)、60.32%(38/63)、50.79%(32/63),均高于非POCD组的32.64%(110/337)、42.73%(144/337)、32.64%(110/337),差异均有统计学意义(P<0.05)。结论 POCD是老年手术患者常见并发症,其发生与受教育年限短、术前合并高血压以及全麻、麻醉时间长等因素有关。

Objective To investigate the incidence and related factors of postoperative cognitive dysfunction(POCD) in elderly patients. Methods A total of 400 cases of elderly patients scheduled for surgery in our hospital from January 2015 to June 2016 were selected. The cognitive dysfunction of these patients was evaluated using Mini-Mental State Examination(MMSE). The patients were diagnosed as having POCD if postoperative MMSE scores decreased by≥4 compared with that before operation. The incidence of POCD was investigated. The patients were divided into two groups for POCD group and non-POCD group according to whether with POCD. The clinical data between the two groups were compared. Results In this study, 63 patients had postoperative POCD, and the incidence was 15.75%. The education attainment of patients in POCD group were(3.2 ± 1.2) years, which were significantly shorter than that of non-POCD group of(4.1 ± 1.7) years. The ratio of hypertension, general anesthesia, anesthesia time>200 min in POCD group were respectively 46.03%(29/63), 60.32%(38/63), 50.79%(32/63), which were significantly higher than those in non-POCD group of 32.64%(110/337), 42.73%(144/337), 32.64%(110/337), and the differences were statistically significant(P<0.05). Conclusion POCD is a common complication in elderly patients after surgery. It is related to the influencing factors as short duration of education, high blood pressure before operation, general anesthesia and long duration of anesthesia.