摘要
目的分析膝关节置换术后老年患者术后认知功能障碍（postoperative cognitive dysfunction，POCD）的影响因素。方法以165例行膝关节置换术的老年患者为研究对象．根据是否出现POCD分为POCD组（35例）和非POCD组（130例）。记录并比较两组患者的性别、年龄、文化程度、疾病史、体育锻炼、手术方式（CR-TKA与PS—TKA）、手术时间、出血量、术前抑郁和术后疼痛评分，采用多因素Logistic回归分析膝关节置换术后老年患者POCI）的影响因素。结果（1）非POCD组和POCD组在MoCA总分及其视空间与执行功能、动物命名和延迟同忆方面，差异有统计学意义（Z=-5．327，P=0．000；Z=-3．140，P=0．002；Z=-2．910，P=0．004；Z=-3．333，P=0．001）。（2）多因素Logistic回归分析显示：≥70岁（OR=3．708，95％CI=1．037—13．261，P〈0．05）、高血压病（OR=5．250，95％CI=1．787～15．423，P〈0．05）、糖尿病（OR=6．560，95％CI=1．418～30．345，P〈0．05）、术前抑郁（OR=4．648，95％ CI=1．290—16．744，P〈0．05）和术后疼痛评分〉4分（OR=3．149，95％ CI=1．072～9．251，P〈0．05）是发生POCD的危险因素，体育锻炼（OR=4．330，95％CI=1．29414．488，P〈0．05）和CR-TKA术式（OR=0．187，95％CI=0．045～0．781，P〈0．05）是影响POCD的保护因素。结论膝关节置换术后老年患者总体认知功能水平较低。高龄、高血压病、糖尿病、缺乏体育锻炼、手术方式选择、术后疼痛和术前抑郁是发生POCD的重要影响因素。
Objective To study the influencing faetors of postoperative cognitive dysfunction （POCD） in elderly patients after knee joint replacement. Methods 165 cases of elderly patients undergoing knee replacement surgery were recruited in the study. According to whether there was POCD,the patients were divided into POCD group （ 35 cases） and non POCD group （ 130 cases）.The gender, age, educational level, medical history, physical exercise, operation mode（ cruciate-retaining total knee arthroplasty and posterior stabilized total knee arthroplasty） , operation time, blood loss, preoperative depression score and postoperative pain score were recorded and compared.The logistic multiveariate regression analysis was conducted to analyze the risk factors of POCD in elderly patients with knee replacement. Results （ 1 ） There were staffs- tically significant differences in the total score of MoCA, visual space and executive function, naming and delaying recall between non-POCD group and POCD group after the operation （ Z=-5.327, P= 0.000; Z= -3.140, P= 0.002; Z=-2.910, P= 0.004; Z=-3.333, P= 0.001 ）. （2）The results of logistic muhiveariate regression analysis showed the age〉70 years old （ OR= 3.708,95% CI = 1.037-13.261, P〈0.05） , hypertension （ OR=5.250,95% CI = 1.787-15.423, P〈0.05） ,diabetes （ OR=6.560,95% CI = 1.418-30.345, P〈 0.05） ,preoperative depression （ OR= 4.648,95% CI = 1.290-16.744, P〈0.05） and postoperative pain score 〉4 （ OR=3.149,95% CI = 1.072-9.251,P〈0.05） were risk factors of POCD,and physical exercise （ OR= 4.330,95% CI = 1.294-14.488, P〈0.05） and CR-TKA（ OR=0.187.95% CI =0.045-0.781, P〈0.05） were the protective factors of POCD. Conclusion The overall level of cognitive function in elderly patients after knee replacement surgery is low. The advanced age, hypertension, diabetes, lack of physical exercise, choice of operation method, postoperative pain and preoperative depression are important influence factors of POCD.
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2017年第2期133-138,共6页
Chinese Journal of Behavioral Medicine and Brain Science
基金
国家自然科学基金项目（81171720）
关键词
老年
膝关节置换术
术后认知功能障碍
危险因素
Elderly
Knee arthroplasty
Postoperative cognitive dysfunction
Risk factors
作者简介
通信作者：张峡，Email：zhangsw199254330@163．com
