CAJ | 학술논문

目的筛选老年脊柱手术患者术后早期认知功能障碍(POCD)的危险因素.方法择期在全身麻醉下行脊柱手术老年患者150例,年龄≥65岁,ASA分级Ⅱ或Ⅲ级.于术前和术后第7天采集静脉血,测定血清S-100B蛋白浓度.根据患者术后第7天是否发生POCD,将其分为POCD组和非POCD组.记录患者年龄、体重、性别、受教育程度、手术类型、合并疾病、术前中医证型、术前1d、术后7d的MMSE评分、手术时间、苏醒时间、术中出血量、及术中心血管事件的发生情况、术中单位时间补液量.采用Logistic回归分析法筛选POCD的危险因素.结果术后早期38例发生POCD,发生率为25.3％.与非POCD组比较,POCD组患者血清S-100B蛋白浓度升高(P＜0.05).Logistic回归分析结果显示:年龄≥70岁、受教育程度小学及以下、手术时间≥5 h、术中低血压次数≥3次为老年脊柱手术患者术后发生POCD的危险因素(P＜0.05).结论年龄≥70岁、受教育程度小学及以下、手术时间≥5h和术中低血压发生次数≥3次是老年患者脊柱手术后早期发生POCD的危险因素.
목적 사선노년척주수술환자술후조기인지공능장애(POCD)적위험인소.방법 택기재전신마취하행척주수술노년환자150례,년령≥65세,ASA분급Ⅱ혹Ⅲ급.우술전화술후제7천채집정맥혈,측정혈청S-100B단백농도.근거환자술후제7천시부발생POCD,장기분위POCD조화비POCD조.기록환자년령、체중、성별、수교육정도、수술류형、합병질병、술전중의증형、술전1d、술후7d적MMSE평분、수술시간、소성시간、술중출혈량、급술중심혈관사건적발생정황、술중단위시간보액량.채용Logistic회귀분석법사선POCD적위험인소.결과 술후조기38례발생POCD,발생솔위25.3％.여비POCD조비교,POCD조환자혈청S-100B단백농도승고(P＜0.05).Logistic회귀분석결과현시:년령≥70세、수교육정도소학급이하、수술시간≥5 h、술중저혈압차수≥3차위노년척주수술환자술후발생POCD적위험인소(P＜0.05).결론 년령≥70세、수교육정도소학급이하、수술시간≥5h화술중저혈압발생차수≥3차시노년환자척주수술후조기발생POCD적위험인소.
Objective To identify the risk factors for early postoperative cognitive dysfunction (POCD) in the elderly patients undergoing spinal surgery.Methods One hundred and fifty ASA Ⅱ or Ⅲ patients,aged ≥65 yr,undergoing elective spinal surgery under general anesthesia,were studied.Venous blood samples were taken at 1 day before operation and 7 days after operation to determine the concentration of serum S-100B protein.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation and 7 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The patients were divided into POCD group and non-POCD group.Age,body weight,sex,education,type of operations,complications,preoperative TCM syndrome type,MMSE score at 1 day before operation and 7 days after operation,duration of operation,emergence time,and intraoperative blood loss,cardiovascular events,and amount of fluid infused per hour were recorded.The risk factors for POCD were analyzed using multivariate logistic regression analysis.Results Thirty-eight patients developed early POCD (25.3％).The resuhs of logistic regression analysis showed that age ≥ 70 yr,elementary education or below,duration of operation ≥5 b,and the number of hypotension occurred during operation≥3 were the risk factors for early POCD.Conclusion Age≥70 yr,elementary education or below,duration of operation ≥ 5 h,and the number of hypotension occurred during operation ≥ 3 are the risk factors for early POCD in the elderly patients undergoing spinal surgery.