• 西安醫(yī)學院第二附屬醫(yī)院普外科(陜西西安 710038);

目的分析老年患者腹部手術后認知功能障礙(POCD)發(fā)生的高危因素。方法回顧性分析我院2000年2月至2010年10月期間60歲以上2 286例腹部手術后患者的臨床資料，根據(jù)是否發(fā)生POCD將2 286例患者分為POCD組和非POCD組，其中POCD組38例，非POCD組2 248例。分析影響腹部手術后POCD發(fā)生的影響因素，包括年齡、性別、麻醉方式、術前是否用藥〔地西泮和(或)阿托品或東莨菪堿〕、術前是否存在心肺疾病、術前是否有糖尿病、術前有無黃疸、術前有無貧血或低蛋白血癥、手術持續(xù)時間及術后是否進行持續(xù)鎮(zhèn)痛治療。結果POCD的發(fā)生與患者年齡、麻醉方式、術前是否存在心肺疾病、術前是否有糖尿病、術前有無黃疸、手術持續(xù)時間是否超過4 h、術后是否進行持續(xù)鎮(zhèn)痛有關(P lt;0.05)，而與患者性別、術前是否用藥和術前有無貧血或低蛋白血癥無關(P gt;0.05)。結論年齡≥70歲、全身麻醉、術前存在心肺疾病、糖尿病和黃疸、手術持續(xù)時間超過4 h、術后未進行持續(xù)有效的鎮(zhèn)痛是腹部手術后POCD發(fā)生的高危因素。

引用本文： 劉利,丁思勤,汪振亮,張華洲. 老年患者腹部手術后認知功能障礙的高危因素分析. 中國普外基礎與臨床雜志, 2011, 18(9): 987-990. doi: 復制

1. Fodale V, Santamaria LB, Schifilliti D, et al. Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer’s disease [J]. Anaesthesia, 2010, 65(4): 388395.
2. Hanning CD. Postoperative cognitive dysfunction [J]. Br J Anaesth, 2005, 95(1): 8287.
3. Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysiology of postoperative cognitive dysfunction [J]. Acta Anaesthesiol Scand, 2010, 54(8): 951956.
4. 黃海兵, 余崇林. 術后認知功能障礙研究新進展 [J]. 中國老年保健醫(yī)學, 2011, 9(1): 5355.
5. Newman S, Stygall J, Hirani S, et al. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review [J]. Anesthesiology, 2007, 106(3): 572590.
6. Diagnostic and Statistical Manual of Mental Disorders [M]. Fourth Edition. American Psychiatry Association, Washington DC, 1994: 273292.
7. Funder KS, Steinmetz J, Rasmussen LS. Methodological issues of postoperative cognitive dysfunction research [J]. Semin Cardiothorac Vasc Anesth, 2010, 14(2): 119122.
8. Fong TG, Fearing MA, Jones RN, et al. Telephone interview for cognitive status: creating a cross walk with the minimental state examination [J]. Alzheimers Dement, 2009, 5(6): 492497.
9. D’Amato CP, Denney RL. The diagnostic utility of the rarely missed index of the Wechsler memory scalethird edition in detecting response bias in an adult male incarcerated setting [J]. Arch Clin Neuropsychol, 2008, 23(5): 553561.
10. 楊純勇, 易斌, 郭巧, 等. 術后認知功能障礙的臨床評估工具進展 [J]. 重慶醫(yī)學, 2010, 39(17): 23192320.
11. Ramaiah R, Lam AM. Postoperative cognitive dysfunction in the elderly [J]. Anesthesiol Clin, 2009, 27(3): 485496.
12. Kalkman C. Can we influence postoperative cognitive dysfunction? [J]. Acta Anaesth Belg, 2007, 58(4): 227229.
13. Mandal PK, Schifilliti D, Mafrica F, et al. Inhaled anesthesia and cognitive performance [J]. Drugs Today (Barc), 2009, 45(1): 4754.
14. Newman MF, Kirchner JL, PhillipsBute B, et al. Longitudinal assessment of neurocognitive function after coronaryartery bypass surgery [J]. N Engl J Med, 2001, 344(6): 395402.
15. Reich DL. Central nervous system protection in cardiac surgery [J]. Semin Cardiothorac Vasc Anesth, 2010, 14(1): 3237.
16. 鮑楊, 史東平, 封衛(wèi)征. 老年患者術后認知功能障礙的研究進展 [J]. 中國老年學雜志, 2009, 29(20): 26892692.
17. Coburn M, Fahlenkamp A, Zoremba N, et al. Postoperative cognitive dysfunction: Incidence and prophylaxis [J]. Anaesthesist, 2010, 59(2): 177184.
18. Bittner EA, Yue Y, Xie Z. Brief review: anesthetic neurotoxicity in the elderly, cognitive dysfunction and Alzheimer’s disease [J]. Can J Anaesth, 2011, 58(2): 216223.
19. Bilotta F, Doronzio A, Stazi E, et al. Postoperative cognitive dysfunction: toward the Alzheimer’s disease pathomechanism hypothesis [J]. J Alzheimers Dis, 2010, 22(3): 8189.
20. Whitmer RA. Type 2 diabetes and risk of cognitive impairment and dementia [J]. Curr Neurol Neurosci Rep, 2007, 7(5): 373380.
21. 孫增榮, 王建華. 2型糖尿病認知功能損害研究進展 [J]. 國際內(nèi)分泌代謝雜志, 2006, 26(1): 5759.
22. Delrieu J, Piau A, Caillaud C, et al. Managing cognitive dysfunction through the continuum of Alzheimer’s disease: role of pharmacotherapy [J]. CNS Drugs, 2011, 25(3): 213226.
23. 姜建利, 席琳, 李寶安, 等. 四種措施防治老年患者術后認知功能障礙的比較 [J]. 中國實用醫(yī)藥, 2010, 5(28): 247248.
24. 趙華, 來怡農(nóng). 星狀神經(jīng)節(jié)阻滯防治老年術后認知功能障礙50例臨床分析 [J]. 中國老年學雜志, 2010, 30(1): 113114.
  1. 1. Fodale V, Santamaria LB, Schifilliti D, et al. Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer’s disease [J]. Anaesthesia, 2010, 65(4): 388395.
  2. 2. Hanning CD. Postoperative cognitive dysfunction [J]. Br J Anaesth, 2005, 95(1): 8287.
  3. 3. Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysiology of postoperative cognitive dysfunction [J]. Acta Anaesthesiol Scand, 2010, 54(8): 951956.
  4. 4. 黃海兵, 余崇林. 術后認知功能障礙研究新進展 [J]. 中國老年保健醫(yī)學, 2011, 9(1): 5355.
  5. 5. Newman S, Stygall J, Hirani S, et al. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review [J]. Anesthesiology, 2007, 106(3): 572590.
  6. 6. Diagnostic and Statistical Manual of Mental Disorders [M]. Fourth Edition. American Psychiatry Association, Washington DC, 1994: 273292.
  7. 7. Funder KS, Steinmetz J, Rasmussen LS. Methodological issues of postoperative cognitive dysfunction research [J]. Semin Cardiothorac Vasc Anesth, 2010, 14(2): 119122.
  8. 8. Fong TG, Fearing MA, Jones RN, et al. Telephone interview for cognitive status: creating a cross walk with the minimental state examination [J]. Alzheimers Dement, 2009, 5(6): 492497.
  9. 9. D’Amato CP, Denney RL. The diagnostic utility of the rarely missed index of the Wechsler memory scalethird edition in detecting response bias in an adult male incarcerated setting [J]. Arch Clin Neuropsychol, 2008, 23(5): 553561.
  10. 10. 楊純勇, 易斌, 郭巧, 等. 術后認知功能障礙的臨床評估工具進展 [J]. 重慶醫(yī)學, 2010, 39(17): 23192320.
  11. 11. Ramaiah R, Lam AM. Postoperative cognitive dysfunction in the elderly [J]. Anesthesiol Clin, 2009, 27(3): 485496.
  12. 12. Kalkman C. Can we influence postoperative cognitive dysfunction? [J]. Acta Anaesth Belg, 2007, 58(4): 227229.
  13. 13. Mandal PK, Schifilliti D, Mafrica F, et al. Inhaled anesthesia and cognitive performance [J]. Drugs Today (Barc), 2009, 45(1): 4754.
  14. 14. Newman MF, Kirchner JL, PhillipsBute B, et al. Longitudinal assessment of neurocognitive function after coronaryartery bypass surgery [J]. N Engl J Med, 2001, 344(6): 395402.
  15. 15. Reich DL. Central nervous system protection in cardiac surgery [J]. Semin Cardiothorac Vasc Anesth, 2010, 14(1): 3237.
  16. 16. 鮑楊, 史東平, 封衛(wèi)征. 老年患者術后認知功能障礙的研究進展 [J]. 中國老年學雜志, 2009, 29(20): 26892692.
  17. 17. Coburn M, Fahlenkamp A, Zoremba N, et al. Postoperative cognitive dysfunction: Incidence and prophylaxis [J]. Anaesthesist, 2010, 59(2): 177184.
  18. 18. Bittner EA, Yue Y, Xie Z. Brief review: anesthetic neurotoxicity in the elderly, cognitive dysfunction and Alzheimer’s disease [J]. Can J Anaesth, 2011, 58(2): 216223.
  19. 19. Bilotta F, Doronzio A, Stazi E, et al. Postoperative cognitive dysfunction: toward the Alzheimer’s disease pathomechanism hypothesis [J]. J Alzheimers Dis, 2010, 22(3): 8189.
  20. 20. Whitmer RA. Type 2 diabetes and risk of cognitive impairment and dementia [J]. Curr Neurol Neurosci Rep, 2007, 7(5): 373380.
  21. 21. 孫增榮, 王建華. 2型糖尿病認知功能損害研究進展 [J]. 國際內(nèi)分泌代謝雜志, 2006, 26(1): 5759.
  22. 22. Delrieu J, Piau A, Caillaud C, et al. Managing cognitive dysfunction through the continuum of Alzheimer’s disease: role of pharmacotherapy [J]. CNS Drugs, 2011, 25(3): 213226.
  23. 23. 姜建利, 席琳, 李寶安, 等. 四種措施防治老年患者術后認知功能障礙的比較 [J]. 中國實用醫(yī)藥, 2010, 5(28): 247248.
  24. 24. 趙華, 來怡農(nóng). 星狀神經(jīng)節(jié)阻滯防治老年術后認知功能障礙50例臨床分析 [J]. 中國老年學雜志, 2010, 30(1): 113114.