【摘要】 目的 探讨不同时间点脑血流量/脑氧代谢率（CBF/CMRO₂）值对老年食管癌患者术后认知功能障碍（POCD）的预测价值。方法 选取140例行手术治疗的老年食管癌患者，根据术后蒙特利尔认知评估（MoCA）量表评分将其分为A组（POCD患者）58例和B组（非POCD患者）82例。比较两组患者的一般资料，以及麻醉诱导前（T₁）、麻醉诱导后2 h（T₂）、麻醉诱导后24 h（T₃）、麻醉诱导后48 h（T₄）的颈静脉球部血氧饱和度（SjvO₂）和CBF/CMRO₂值。绘制受试者工作特征（ROC）曲线，评估不同时间点CBF/CMRO₂值对老年食管癌患者发生POCD的预测价值。结果 两组患者的SjvO₂比较，差异无统计学意义（P>0.05）。两组患者的CBF/CMRO₂值比较，差异有统计学意义（P<0.05），两组的CBF/CMRO₂值均有随时间变化的趋势（均P<0.05），其中A组T₂、T₃时的CBF/CMRO₂值均低于B组（均P<0.05）。ROC曲线分析结果显示，T₁、T₂、T₃、T₄的CBF/CMRO₂值预测老年食管癌患者发生POCD的曲线下面积（AUC）分别为0.521、0.821、0.698、0.555，其中T₁与T₄的AUC差异无统计学意义（P>0.05），而T₂、T₃、T₄的AUC依次降低（均P<0.05）。结论 CBF/CMRO₂值与老年食管癌患者发生POCD相关，麻醉诱导后2 h监测CBF/CMRO₂值能较好地预测老年食管癌患者POCD的发生。更多还原

【Abstract】 Objective To investigate the predictive value of cerebral blood flow/cerebral metabolic rate of oxygen（CBF/CMRO₂）value at different time points on postoperative cognitive dysfunction（POCD）in elderly patients with esophageal carcinoma.Methods A total of 140 elderly patients with esophageal carcinoma undergoing surgical treatment were selected,and they were assigned to group A（POCD patients,58 cases）or group B（non-POCD patients,82 cases）according to the postoperative Montreal Cognitive Assessment（MoCA）scale score.The general data,and jugular venous bulb oxygen saturation（SjvO₂）and CBF/CMRO₂value before anesthesia induction（T₁）,2 hours after anesthesia induction（T₂）,24 hours after anesthesia induction（T₃）,48 hours after anesthesia induction（T₄）were compared between the two groups.The receiver operating characteristic（ROC）curve was drawn to evaluate the predictive value of CBF/CMRO₂value at different time points on the occurrence of POCD in elderly patients with esophageal carcinoma.Results There was no statistically significant difference in SjvO₂of patients between the two groups（P>0.05）.There was a statistically significant difference in CBF/CMRO₂value between the two groups（P<0.05）,and CBF/CMRO₂value in both groups exhibited a trend of changes over time（allP<0.05）,therein group A yielded lower CBF/CMRO₂value at T₂and T₃as compared with group B（allP<0.05）.The results of ROC curve analysis revealed that the areas under the curve（AUC）of CBF/CMRO₂value at T₁,T₂,T₃,and T₄in predicting the occurrence of POCD in elderly patients with esophageal carcinoma were 0.521,0.821,0.698,and0.555,among which no statistically significant difference in AUC was found between T₁and T₄（P>0.05）,whereas AUC at T₂,T₃,and T₄was decreased successively（allP<0.05）.Conclusion CBF/CMRO₂value is related to the occurrence of POCD in patients with esophageal carcinoma,monitoring CBF/CMRO₂value at 2 hours after anesthesia induction can preferably predict the occurrence of POCD in elderly patients with esophageal carcinoma.更多还原