【摘要】 目的探讨影响高龄（年龄≥55岁）患者腹腔镜术后认知功能障碍发生的因素。方法纳入大冶市人民医院和阳新县人民医院2014年9月14日至2016年1月1日期间以及大冶市中医院2014年6月19日至2016年1月1日期间收治的腹腔镜手术患者为研究对象。登记所纳入患者的一般情况,并记录患者围手术期影响腹腔镜手术后可能引起术后认知功能障碍发生的因素,采用多因素logistic回归分析研究腹腔镜手术患者继发认知功能障碍的独立影响因素。结果根据纳入和排除标准,最终于三家医院共纳入378例接受腹腔镜手术的高龄患者,其中有43例患者于术后3 d内发生认知功能障碍,335例患者于术后3 d内未发生认知功能障碍,二者的性别、年龄等基线资料比较差异无统计学意义（P>0.05）。合并脑梗塞、术前恐惧、超前镇痛、术前使用右美托咪啶、全身麻醉联合连续硬膜外阻滞麻醉、手术时间、麻醉诱导中低血氧饱和度（SpO₂）、气腹后二氧化碳分压（PaCO₂）、术后患者自控硬膜外镇痛（PCEA）、术后3 d VAS评分与术后发生认知功能障碍有关（P<0.05）,进一步logistic回归分析显示,超前镇痛、术前使用右美托咪啶、全身麻醉联合连续硬膜外阻滞麻醉、手术时间、气腹后PaCO₂及术后PCEA进入最终回归模型,其中超前镇痛、术前使用右美托咪啶、全身麻醉联合连续硬膜外阻滞麻醉及术后PCEA为术后认知功能障碍发生的独立保护因素（P<0.05）;手术时间和气腹后PaCO₂为术后认知功能障碍发生的独立危险因素（P<0.05）。结论对于行腹腔镜手术的高龄患者,若具备本研究中的影响因素,临床医生应充分警惕术后认知功能障碍的发生,及时进行相关量表筛查,从而做到尽早发现、尽早干预,有效延缓该患者的术后认知功能障碍进展。更多还原

【Abstract】 Objective To investigate influencing factors of postoperative cognitive dysfunction（POCD） in elderly patients underwent laparoscopic surgery. Methods The elderly patients underwent laparoscopic surgery were collected in the Daye City People’s Hospital and Yangxin County People’s Hospital from September 14, 2014 to January 1, 2016 and the Traditional Chinese Medicine Hospital of Daye City from June 19, 2014 to January 1, 2016. Factors included in the registration of patients in general and a variety of influencing factors during perioperative period were recorded. The independent factors associated with POCD were analyzed by multivariate logistic regression analysis. Results Three hundred and seventy-eight elderly patients underwent laparoscopic surgery were included according to the inclusion and exclusion criteria, of which 43 patients with POCD and 335 patients without POCD within 3 days after laparoscopic surgery. The baseline data had no significant differences between the patients with POCD and without POCD. The cerebral infarction, preoperative fear, preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, operation time, low SpO₂ during anesthesia induction, PaCO₂ after pneumoperitoneum,postoperative patient controlled epidural analgesia（PCEA）, postoperative VAS score on day 3 were associated with the POCD（P<0.05）. The results of logistic regression analysis showed that the preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, and postoperative PCEA were the independent protective factors of the POCD（P<0.05）. The operation time and PaCO₂ after pneumoperitoneum were the independent risk factors of the POCD（P<0.05）. Conclusion For elderly patients underwent laparoscopic surgery, clinicians should be alert to occurrence of POCD according to the influence factors of it, and timely screen relevant scale so as to early diagnose and early intervent and effectively delay progress of patient’s POCD.更多还原