Objective To study the risk factors of postoperative cognitive dysfunction (POCD) in elderly pa-tients. Methods Eighty patients undergoing gastrointestinal surgery or urinary surgery in our hospital from March 2012 to March 2014 were selected as research subjects, which were randomly divided into general anesthesia group and combined spinal epidural group according to the numbers, with 40 patients in each group. MMSE scores of the patients were determined before and after surgery. The occurrences of POCD of different period after surgery were compared be-tween the two groups, and the risk factors for POCD were analyzed. Results The two groups showed no statistically significant difference in MMSE score between before anesthesia, postoperative 1 d and 3 d (P>0.05). At postoperative 6 h and 12 h, MMSE scores in the combined spinal epidural group were significantly higher than those in general anesthesia group (P<0.05), and the incidence of POCD in the combined spinal epidural group were significantly lower (P<0.05). Pa-tients with POCD tended to have received significantly shorter duration of education and more gastrointestinal surgeries, compared with those without POCD (P<0.05). According to logistic regression analysis, short duration of education and gastrointestinal surgeries were the risk factors of POCD. Conclusion Combined spinal epidural anesthesia can effec-tively reduce the incidence of POCD in elderly patients. The risk factors for the occurrence of POCD in elderly patients should be paid attention to, and active prevention measures should be taken.%目的 分析老年患者术后认知功能障碍(POCD)的危险因素.方法 选择2012年3月至2014年3月在我院接受胃肠手术、泌尿外科手术治疗的80例患者作为研究对象,按数字法随机分成全麻组及腰硬联合组各40例,于手术前后分别用简易智力状态检查量表(MMSE)进行评分,比较两组患者术后不同时期的POCD发生情况,分析导致POCD发生的危险因素.结果 两组麻醉前、术后1 d及3 d的MMSE评分相比,差异均无统计学意义(P>0.05);腰硬联合组在术后6 h及术后12 h的MMSE评分均明显高于全麻组,POCD发生率均明显少于全麻组,差异均有统计学意义(P<0.05);发生POCD的患者受教育年限明显少于未发生POCD者,接受胃肠手术的比例明显多于未发生POCD者,差异均有统计学意义(P<0.05).Logistic回归法分析表明教育年限短及胃肠外科手术均为POCD发生的危险因素.结论 老年手术患者选择腰硬联合麻醉能够降低POCD发生率,临床上应关注老年患者发生POCD的危险因素,积极进行防治.
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