老年胃肠癌患者术前认知功能障碍与术后谵妄的相关性分析OA
Correlation analysis between preoperative cognitive dysfunction and postoperative delirium in elderly patients with gastrointestinal cancer
目的 分析老年胃肠癌患者术前认知功能障碍与术后谵妄(postoperative delirium,POD)的相关性.方法 选取2023年9月至2025年10月常州市第七人民医院收治的120例行根治性手术的老年胃肠癌患者为研究对象.采用蒙特利尔认知功能评估量表(Montreal cognitive assessment scale,MoCA量表)评估患者术前1 d的认知功能,MoCA量表评分＜26分为认知功能障碍组(n=46),余为认知功能正常组(n=74);根据意识错乱评估法的结果,出现谵妄者为POD组(n=20),余为无POD组(n=100).比较两组患者的临床资料、术后住院时间及术前MoCA量表评分,采用多因素Logistic回归分析老年胃肠癌患者术前认知功能障碍与POD的相关性.结果 全部120例老年胃肠癌患者术前有46例(38.3%)存在认知功能障碍,术后共发现20例(16.7%)POD,经过积极治疗后均顺利康复出院,未发生围手术期死亡者.认识功能障碍组患者POD的发生率显著高于认知功能正常组患者,术后住院时间显著长于认知功能正常组患者(P＜0.05).POD组患者的术前MoCA量表评分,已婚构成比,术前血红蛋白(hemoglobin,Hb)、白蛋白(albumin,Alb)、Ca2+水平显著低于无POD组(P＜0.05);POD组患者的术后住院时间、手术时间显著长于无POD组(P＜0.05);POD组患者的年龄,饮酒史构成比,术中低血压、缺氧的发生率显著高于无POD组(P＜0.05).多因素Logistic回归分析结果表明术前低MoCA量表评分、术前低Alb水平、术中缺氧是老年胃肠癌患者发生POD的独立影响因素(P＜0.05).结论 老年胃肠癌患者术前认知功能障碍是POD发生的独立影响因素,改善术前认知功能能降低POD发生风险.
Objective To investigate the correlation analysis between preoperative cognitive dysfunction and postoperative delirium(POD)in elderly patients with gastrointestinal cancer.Method The Montreal cognitive assessment(MoCA)scale was used to assess the cognitive function of 120 patients with gastrointestinal cancer at one day before surgery.Based on the results,patients were divided into a cognitive dysfunction group and a normal cognitive function group.According to the results of confusion assessment method,patients were further divided into a POD group and a non-POD group.The clinical data,postoperative hospitalization time and preoperative MoCA score were compared between the two groups.Multivariate logistic regression analysis was performed to analyze the correlation between preoperative cognitive dysfunction and POD in elderly patients with gastrointestinal cancer.Result Among all 120 elderly patients with gastrointestinal cancer,46(38.3%)exhibited cognitive dysfunction before surgery,and 20(16.7%)patients developed POD.All patients of POD recovered smoothly after aggressive treatment and were discharged without perioperative mortality.The incidence of POD and postoperative hospital stay in the cognitive dysfunction group were significantly higher than those in the normal cognitive function group(P＜0.05).The preoperative MoCA scores of patients in the POD group were significantly lower than those in the non-POD group,while their postoperative hospital stay was significantly longer than that of the non-POD group(P＜0.05).The preoperative MoCA scores,proportion of married patients,preoperative blood Hb,Alb,and Ca2+levels in the POD group were significantly lower than those in the non-POD group,while postoperative hospitalization duration,age,operation duration,proportion of alcohol consumption history,intraoperative hypotension and hypoxia in the POD group were significantly higher than in the non-POD group(P＜0.05).Multivariate logistic regression analysis indicated that preoperative MoCA scores,serum albumin levels,and intraoperative hypoxia were independently associated with POD in elderly patients with gastrointestinal cancer(P＜0.05).Conclusion There is a close correlation between preoperative cognitive dysfunction and the occurrence of POD in elderly patients with gastrointestinal cancer.Higher the preoperative MoCA scale scores may reduce the risk of POD,which deserves clinical attention.
邓莉健;王玉华;徐金玉;陆常玉;莫炜烈
常州市第七人民医院 肿瘤科,江苏 常州 213000常州市第七人民医院 住院部,江苏 常州 213000常州市第七人民医院 护理部,江苏 常州 213000常州市第七人民医院 肿瘤科,江苏 常州 213000常州市第七人民医院 胃肠外科,江苏 常州 213000
术后谵妄认知功能障碍老年胃肠癌蒙特利尔认知功能评估量表
Postoperative deliriumCognitive dysfunctionElderlyGastrointestinal cancerMontreal cognitive assessment scale
《肿瘤综合治疗电子杂志》 2026 (2)
37-43,7
2023年常州市卫健委科技项目(第二批)(QN202378)
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