标题：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

      作者：陆立仁 1，郭翠容 2，郑映金 1，莫平 1，赵丽珍 1，王志强 2
    (1.南方医科大学附属南海医院麻醉科，广东 佛山 528000；
2.佛山市南海区妇幼保健院麻醉科，广东 佛山 528200)

      卷次： 2016年27卷19期

      【摘要】 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。方法 2014年1
月至2015年3月，南方医科大学附属南海医院与佛山市南海区妇幼保健院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、患者受教育程度、患者家庭情况(是否独居)、BMI、年龄、麻醉时间、舒芬太尼用
量、术后血Hct、定向力恢复时间、麻醉复苏期躁动情况、术后疼痛情况。于术后7 d (早期)和术后3个月(远期)采用
MMSE评分表进行认知功能测试，采用Z计分法判断POCD，记录其发生情况。丙泊酚麻醉与七氟醚麻醉各50例，根
据患者是否发生POCD分为POCD组和非POCD组。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%；POCD组与非POCD组患者的手术史、BMI、年龄、麻醉方
式、术后血Hct、定向力恢复时间、术后疼痛程度进行Logistic回归分析，结果显示，七氟醚麻醉(OR=2.812 1，95%CI=
1.099~7.240)、术后疼痛(OR=2.292，95%CI=1.129~4.654)为腹腔镜下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%；POCD组与非POCD组患者的受教育年限和独居比率进行Logistic回归分析，结果
显示，独居(OR=5.517，95%=1.010~30.126)是腹腔镜下广泛性子宫切除术患者远期POCD的危险因素。结论 腹腔
镜广泛性子宫切除术患者早期POCD的危险因素为七氟醚麻醉和术后疼痛，远期POCD的危险因素为独居。

      【关键词】 术后认知功能障碍；根治性广泛全子宫切除术；腹腔镜；危险因素

      【中图分类号】 R713.4+2 【文献标识码】 A 【文章编号】 1003—6350（2016）19—3164—04


Risk factors analysis for postoperative cognitive dysfunction in patients undergoing laparoscopic radical
hysterectomy.
LU Li-ren 1, GUO Cui-rong 2. ZHENG Ying-jin 1, MO Ping 1, ZHAO Li-zhen 1, WANG Zhi-qiang 2.
1. Department of Anesthesiology, Nanhai Hospital Affiliated to Southern Medical University, Foshan 528000, Guangdong,
CHINA; 2. Department of Anesthesiology, Nanhai Maternity and Child Healthcare Hospital, Foshan 528200, Guangdong,
CHINA

【Abstract】 Objective To screen the risk factors for postoperative cognitive dysfunction (POCD) in patients un-
dergoing laparoscopic radical hysterectomy. Methods One hundred patients undergoing laparoscopic radical hysterec-
tomy in Nanhai Hospital Affiliated to Southern Medical University and Nanhai Maternity and Child Healthcare Hospital
from January 2014 to March 2015 were included. The surgical history, general anesthetics, education, home environment
(whether to live alone), body mass index (BMI), age, duration of anesthesia, dosage of sufentanil, postoperative blood he-
matocrit (Hct), the time for regaining orientation, agitation during recovery period of anesthesia and postoperative pain de-
gree were recorded. The cognitive function test of patients was assessed by mini-mental state examination (MMSE) at 7
days (early period) and 3 months (later period) after surgery. Z scoring method was used to determine the POCD, and its
occurrence was recorded. Patients were administrated with propofol (n=50) or sevoflurane (n=50), and the patients were
divided into POCD group or non-POCD group according to whether patients with POCD. Logistic regression analysis was
conducted to screen the risk factors of POCD with statistically significant differences between the groups. Results The
incidence of POCD at early period was 29.0%. Surgical history, BMI, age, anesthesia methods, Hct, the time for regaining
orientation, postoperative pain degree were performed logistic regression analysis between the two groups, and results
showed that sevoflurane anesthesia (OR=2.8121, 95% CI=1.099-7.240) and postoperative pain (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%.
The education and ratio of living alone was performed logistic regression analysis between the two groups, and results
showed that living alone (OR=5.517, 95% CI=1.010-30.126) was the significant risk factor for POCD at later period.
Conclusion Sevoflurane anestlesia and postoperative pain are the significant risk factors for early POCD in patients un-
dergoing laparoscopic radical hysterectomy, and living alone is the long-term risk factor for POCD after surgery.

      【Key words】 Postoperative cognitive dysfunction (POCD); Radical hysterectomy; Laparoscopic; Risk factors
·论 著·doi:10.3969/j.issn.1003-6350.2016.19.023
基金项目：广东省佛山市医学类科技攻关项目(编号：2014AB000602)