目的 分析无痛上消化道内镜(EGD)检查对老年受试者认知功能的影响,探究引起认知功能障碍的危险因素.方法 选取2015年8月至2016年8月于西安市北方医院行无痛EGD检查的94例老年患者(观察组)和同期入院行普通EGD检查的94例老年患者(对照组)为受试对象,均于检查前、达到离院标准时予以认知功能测试,若检查结束后测试结果明显差于检查前,则静息0.5h后再次重复试验,直至达到检查前水平才可离院;比较两组重复测试率及检查结束至正式离院时间间隔差异.根据认知功能测试结果将观察组患者分为认知障碍组和非认知障碍组,比较其性别、年龄、文化程度、麻醉方式、操作时间、检查类型、检查前不良情绪评估结果[汉密尔顿抑郁/焦虑量表(HAMD/HAMA)]等差异,对单因素分析后存在统计学意义的指标行非条件Logistic多元逐步回归分析.结果 两组患者均参加两次(检查前和达到离院标准时)认知功能测试.观察组患者的重复测试率为44.7%,检查结束至正式离院时间间隔为(58.3±13.3)min,均明显高于对照组的19.2%、(34.2±9.5)min,差异均有统计学意义(P<0.05);观察组患者中,经认知功能测试纳入认知功能障碍组者42例,剩余52例纳入非认知功能障碍组,两组患者的文化程度、麻醉方式比较差异均无统计学意义(P>0.05),而性别、年龄、操作时间、检查类型、检查前不良情绪评估结果等指标比较差异均有统计学意义(P<0.05);非条件Logistic多元逐步回归分析结果显示,性别、年龄、操作时间、检查前存在不良情绪等均为影响无痛EGD患者认知功能障碍的独立危险因素(OR值=1.448、1.533、4.264、2.052,P<0.05).结论 无痛EGD检查可能致短时认知功能障碍发生,其原因可能与受试者年龄、性别、操作时间短、检查前有不良情绪等关系密切,患者适当延长离院时间即可缓解相关症状.%Objective To analyze the effect of painless upper gastrointestinal endoscopy(EGD)on cognitive function in elderly subjects, and explore the risk factors for cognitive dysfunction. Methods During the period from August 2015 to August 2016,94 elderly patients who underwent painless EGD in the Northern Hospital of Xi'an City (observation group)and 94 patients undergoing routine EGD during the same period(control group)were selected as the study subjects.The cognitive function test was performed before examination and when reaching the standard of leaving the hospital.If the test results were significantly worse than those before the test,the rest was performed again after 0.5 h of rest,and patients could leave the hospital till the results recovered to the level before test.The rate of repeat test and the time from the end of the test to the time of leaving hospital were compared between the two groups.According to the test results of cognitive function,patients in the observation group were divided into the cognitive dysfunction group and non-cognitive dysfunction group.The gender,age,education level,anesthesia methods,operation time,types of examina-tions, unhealthy emotions before examination (Hamilton Depression/Anxiety Scale [HAMD/HAMA]) were compared. Factors with statistically significant differences after univariate analysis were analyzed by the non-conditional Logistic multiple stepwise regression analysis.Results Patients in the two groups received twice cognitive function tests before examination and after reaching the standard of leaving hospital.The rate of repeat test and the time from the end of the test to the time of leaving hospital in the observation group were significantly higher/longer than those in the control group: 44.7% vs 19.2%, (58.3 ± 13.3) min vs (34.2 ± 9.5) min, both P<0.05.Among the 94 patients in the observation group, 42 were included in the cognitive dysfunction group and the other 52 cases were included in the non-cognitive dysfunction group.There was no significant difference between the two groups in the educational level and anesthesia methods(P>0.05),but there were statistically significant differences in gender,age,operation time,type of examination and evaluation results (HAMD, HAMA) of adverse emotions before operation (P<0.05). Non-conditional Logistic re-gression analysis showed that gender,age,operation time and unhealthy emotions before examination were the indepen-dent risk factors for cognitive dysfunction in patients receiving painless EGD(OR=1.448,1.533,4.264,2.052,P<0.05). Conclusion Painless EGD may cause short-term cognitive dysfunction,and the reasons may be closely related to age, gender,short operation time and unhealthy emotions before examination.Appropriately prolonging the time of leaving the hospital can relieve the related symptoms.
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