Analysis of Influencing Factors of Postoperative Cognitive Dysfunction Following Laparoscopic Surgery in Elderly Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANJing ¹ ,  XIAOKe-min ¹ , FANGTao ² , ZOUZhi-yi ¹ , WUJian-qing ¹

1. Department of General Surgery, Daye City People's Hospital, Daye 435100, Hubei Province, China;
2. Department of General Surgery, Yangxin County People's Hospital, Yangxin 435200, Hubei Province, China;

Corresponding?author：

XIAOKe-min, Email: hsbxkm@163.com

Keywords：

Laparoscopy; Elderly patient; Postoperative cognitive dysfunction; Influencing factor

DOI：

10.7507/1007-9424.20160254

Video：

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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.

Citation： YANJing, XIAOKe-min, FANGTao, ZOUZhi-yi, WUJian-qing. Analysis of Influencing Factors of Postoperative Cognitive Dysfunction Following Laparoscopic Surgery in Elderly Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(8): 972-977. doi: 10.7507/1007-9424.20160254 Copy

1.	鮑寧, 呂黃偉, 劉鋼.二氧化碳氣腹對婦科腹腔鏡手術患者術后早期認知功能的影響.中國血液流變學雜志, 2010, 20(2):253-255.
2.	龔旭華, 李鵬, 易斌, 等.婦科腹腔鏡與開腹手術對老年患者術后認知功能的影響.重慶醫學, 2010, 39(17):2290-2291.
3.	吳丹.七氟醚和異丙酚全身麻醉對老年患者麻醉后蘇醒時間及術后認知功能的影響對比.中國藥業, 2013, 22(5):95-96.
4.	李寶永, 蒲國華, 劉鐵軍.右美托咪定與亞麻醉劑量氯胺酮對老年患者腹腔鏡膽囊術后認知功能的影響.中國醫刊, 2015, 4(4):86-88.
5.	孫振濤, 孫雪青, 韓雪萍, 等.不同呼吸參數對婦科腹腔鏡手術后早期認知功能的影響.臨床麻醉學雜志, 2014, 30(7):686-688.
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7.	中華醫學會神經病學分會癡呆與認知障礙學組寫作組, 中國阿爾茨海默病協會(ADC).中國癡呆與認知障礙診治指南:輕度認知障礙的診斷和治療.中華醫學雜志, 2010, 90(41):2887-2893.
8.	Lee CN, Ko D, Suh YW, et al. Cognitive functions and stereopsis in patients with Parkinson, s disease and Alzheimer's disease using 3-dimensional television:a case controlled trial. PLoS One, 2015, 10(3):e0123229.
9.	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.重慶醫學, 2010, 39(17):2319-2320.
10.	American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care, 2014, 37(Suppl 1):S14-S80.
11.	中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組.中國急性缺血性腦卒中診治指南(2010年版).中華神經科雜志, 2010, 43(2):146-153.
12.	中國高血壓防治指南修訂委員會.中國高血壓防治指南2010.中華心血管病雜志, 2011, 39(7):579-616.
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15.	Rohan D, Buggy DJ, Crowley S, et al. Increased incidence of postoperative cognitive dysfunction 24 hour after minor surgery in the elderly. Can J Anaesth, 2005, 52(2):137-142.
16.	姚立農, 張宏.老年人術后認知功能障礙的研究現狀.國外醫學:麻醉學與復蘇分冊, 2001, 22(4):217-220.
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18.	岳英, 張建光, 王偉, 等. 632名術后抑郁癥發病率及其認知功能障礙分析.河北北方學院學報, 2006, 23(2):58-59.
19.	Monk TG, Weidon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major no cardiac surgery. Anesthesiology, 2008, 108(1):18-30.
20.	方梅, 董志紅, 張冰.右美托咪啶對老年患者腹腔鏡下宮頸癌根治術后早期認知功能的影響.中華麻醉學雜志, 2012, 32(6):699-701.
21.	薛金配, 王軍, 宗川曰, 等.右美托咪定預防胃癌根治術患者全麻蘇醒期躁動45例觀察.陜西醫學雜志, 2014, 43(1):96-97.
22.	Lasarzik I, Noppens RR, Wolf T, et al. Dose-dependent influence of sevoflurane anesthesia on neuronal survival and cognitive outcome after transient forebrain ischemia in Sprague-Dawley rats. Neurocrit Care, 2011, 15(3):577-584.
23.	王云川, 陳有英, 王軍, 等.硬膜外阻滯對老年全身麻醉下腹腔鏡結腸癌根治術后認知功能的影響.重慶醫學, 2015, 40(18):2499-2503.
24.	龔濤武, 朱昭瓊, 鄭雪, 等.不同全身麻醉方法對腹腔鏡膽囊切除術后早期認知功能的影響.第三軍醫大學學報, 2013, 35(1):50-53.
25.	Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth, 2009, 103 Suppl 1:i41-i46.
26.	Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3):206-117.
27.	鮑寧, 呂黃偉.二氧化碳氣腹對婦科腹腔鏡手術患者術后早期認知功能S-100β和NSE的影響.中國醫師雜志, 2010, 12(8):1033-1036.

1. 鮑寧, 呂黃偉, 劉鋼.二氧化碳氣腹對婦科腹腔鏡手術患者術后早期認知功能的影響.中國血液流變學雜志, 2010, 20(2):253-255.
2. 龔旭華, 李鵬, 易斌, 等.婦科腹腔鏡與開腹手術對老年患者術后認知功能的影響.重慶醫學, 2010, 39(17):2290-2291.
3. 吳丹.七氟醚和異丙酚全身麻醉對老年患者麻醉后蘇醒時間及術后認知功能的影響對比.中國藥業, 2013, 22(5):95-96.
4. 李寶永, 蒲國華, 劉鐵軍.右美托咪定與亞麻醉劑量氯胺酮對老年患者腹腔鏡膽囊術后認知功能的影響.中國醫刊, 2015, 4(4):86-88.
5. 孫振濤, 孫雪青, 韓雪萍, 等.不同呼吸參數對婦科腹腔鏡手術后早期認知功能的影響.臨床麻醉學雜志, 2014, 30(7):686-688.
6. Park EY, Koo BN, Min KT, et al. The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand, 2009, 53(7):895-899.
7. 中華醫學會神經病學分會癡呆與認知障礙學組寫作組, 中國阿爾茨海默病協會(ADC).中國癡呆與認知障礙診治指南:輕度認知障礙的診斷和治療.中華醫學雜志, 2010, 90(41):2887-2893.
8. Lee CN, Ko D, Suh YW, et al. Cognitive functions and stereopsis in patients with Parkinson, s disease and Alzheimer's disease using 3-dimensional television:a case controlled trial. PLoS One, 2015, 10(3):e0123229.
9. 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.重慶醫學, 2010, 39(17):2319-2320.
10. American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care, 2014, 37(Suppl 1):S14-S80.
11. 中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組.中國急性缺血性腦卒中診治指南(2010年版).中華神經科雜志, 2010, 43(2):146-153.
12. 中國高血壓防治指南修訂委員會.中國高血壓防治指南2010.中華心血管病雜志, 2011, 39(7):579-616.
13. 中國成人血脂異常防治指南制訂聯合委員會.中國成人血脂異常防治指南.中華心血管病雜志, 2007, 35(5):390-419.
14. 莊心良, 曾因明, 陳伯鑾, 等.現代麻醉學.北京:人民衛生出版社, 2003:598-600.
15. Rohan D, Buggy DJ, Crowley S, et al. Increased incidence of postoperative cognitive dysfunction 24 hour after minor surgery in the elderly. Can J Anaesth, 2005, 52(2):137-142.
16. 姚立農, 張宏.老年人術后認知功能障礙的研究現狀.國外醫學:麻醉學與復蘇分冊, 2001, 22(4):217-220.
17. 饒佳華, 姜虹.老年人術后認知功能障礙研究進展.醫學綜述, 2008, 14(16):2473-2475.
18. 岳英, 張建光, 王偉, 等. 632名術后抑郁癥發病率及其認知功能障礙分析.河北北方學院學報, 2006, 23(2):58-59.
19. Monk TG, Weidon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major no cardiac surgery. Anesthesiology, 2008, 108(1):18-30.
20. 方梅, 董志紅, 張冰.右美托咪啶對老年患者腹腔鏡下宮頸癌根治術后早期認知功能的影響.中華麻醉學雜志, 2012, 32(6):699-701.
21. 薛金配, 王軍, 宗川曰, 等.右美托咪定預防胃癌根治術患者全麻蘇醒期躁動45例觀察.陜西醫學雜志, 2014, 43(1):96-97.
22. Lasarzik I, Noppens RR, Wolf T, et al. Dose-dependent influence of sevoflurane anesthesia on neuronal survival and cognitive outcome after transient forebrain ischemia in Sprague-Dawley rats. Neurocrit Care, 2011, 15(3):577-584.
23. 王云川, 陳有英, 王軍, 等.硬膜外阻滯對老年全身麻醉下腹腔鏡結腸癌根治術后認知功能的影響.重慶醫學, 2015, 40(18):2499-2503.
24. 龔濤武, 朱昭瓊, 鄭雪, 等.不同全身麻醉方法對腹腔鏡膽囊切除術后早期認知功能的影響.第三軍醫大學學報, 2013, 35(1):50-53.
25. Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth, 2009, 103 Suppl 1:i41-i46.
26. Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3):206-117.
27. 鮑寧, 呂黃偉.二氧化碳氣腹對婦科腹腔鏡手術患者術后早期認知功能S-100β和NSE的影響.中國醫師雜志, 2010, 12(8):1033-1036.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Influencing Factors of Postoperative Cognitive Dysfunction Following Laparoscopic Surgery in Elderly Patients

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