标题：全麻腹腔镜手术对老年直肠癌患者术后认知功能的影响及危险因素分析

      作者：安慎通，皇甫加文，闵昱源    空军军医大学第一附属医院麻醉与围术期医学科，陕西 西安 710000

      卷次： 2020年31卷9期

      【摘要】 目的 分析老年直肠癌患者行全麻腹腔镜术后认知功能障碍(POCD)发生情况，并探讨影响POCD的危险因素。方法 选取2018年1月至2019年1月在空军军医大学第一附属医院择期行全麻腹腔镜直肠癌手术治疗的84例老年患者，手术前后采用简易精神状态量表(MMSE)对患者认知功能进行评价；收集患者围术期临床资料，应用单因素分析和多因素Logistic回归模型分析影响POCD的危险因素。结果 老年直肠癌患者行全麻腹腔镜术后POCD发生率为23.81%；单因素分析结果显示，年龄、ASA分级、糖尿病、SIRS评分及术后禁食时间与术后POCD发生相关(P<0.05)；多因素Logistic回归分析结果显示，高龄(OR=1.439，95%CI：1.155~1.792)、糖尿病史(OR=4.166，95%CI：1.607~10.800)、术后SIRS评分高(OR=3.337，95%CI：1.482~7.512)和术后禁食天数≥3 d (OR=2.872，95%CI：1.251~6.593)是老年直肠癌行腹腔镜根治术后早期POCD的独立危险因素(P<0.05)。结论 老年直肠癌患者行全麻腹腔镜根治术后POCD发生率高，高龄、合并糖尿病史、术后SIRS评分高及术后禁食天数≥3 d是术后早期POCD的独立危险因素。
      【关键词】 直肠癌根治术；腹腔镜；全身麻醉；认知功能障碍；危险因素
      【中图分类号】 R735.3+7 【文献标识码】 A 【文章编号】 1003—6350（2020）09—1149—03

Effects of laparoscopic general anesthesia surgery on postoperative cognition function in elderly patients withrectal cancer and risk factors.
AN Shen-tong, HUANGFU Jia-wen, MIN Yu-yuan. Department of Anesthesiology andPerioperative Medicine, First Affiliated Hospital of Air Force Military Medical University, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To analyze the occurrence of postoperative cognitive dysfunction (POCD) in elderly patientswith rectal cancer undergoing laparoscopic general anesthesia surgery, and to explore its risk factors. Methods Eighty-fourelderly patients who was scheduled for underwent laparoscopic surgery for rectal cancer under general anesthesia in the FirstAffiliated Hospital of Air Force Military Medical University from January 2018 to January 2019 were enrolled. Before andafter surgery, cognition function was evaluated by mini-mental state examination (MMSE). Perioperative clinical data ofthe patients were collected. The univariate analysis and multivariate Logistic regression model were applied to analyzethe risk factors influencing POCD. Results After surgery, incidence of POCD was 23.81%. Univariate analysis indicat-ed that age, ASA grade, diabetes mellitus, SIRS score, and postoperative fasting time were related to occurrence of post-operative POCD (P<0.05). The results of multivariate Logistic regression analysis indicated that elderly age (OR=1.439,95% CI: 1.155-1.792), history of diabetes mellitus (OR=4.166, 95%CI: 1.607-10.800), high postoperative SIRS score(OR=3.337, 95%CI: 1.482-7.512), and postoperative fasting time not shorter than 3 d (OR=2.872, 95%CI: 1.251-6.593)were independent risk factors of early POCD in elderly patients with rectal cancer after laparoscopic radical surgery (P<0.05). Conclusion The incidence of POCD is high in elderly patients with rectal cancer undergoing laparoscopic radi-cal resection under general anesthesia. Elderly age, history of diabetes mellitus, high postoperative SIRS score, and post-operative fasting time≥3 d were the independent risk factors of early POCD.
      【Key words】 Radical resection of rectal cancer; Laparoscope; General anesthesia; Cognitive dysfunction; Riskfactor