加速康复外科预防老年结直肠肿瘤患者择期手术后认知功能障碍发生的效果

摘要

Objective To investigate the role of enhanced recovery after surgery (EARS) in preventing the develop-ment of postoperative cognitive dysfunction (POCD) in elderly patients with elective colorectal surgery. Method 66 el-derly patients with elective colorectal surgery were included in the study and randomized as study group or control group, managed with traditional perioperative procedures or EARS protocols, respectively. The Mini-Mental State Examination (MMSE) scores on 7th day before and after surgery, and the C-reactive protein (CRP0, CRP1, CRP3, CRP7) in acute phase on 1st, 3rd, and 7th day before and after surgery in the two groups were compared, besides, the usage of sevoflurane, opioids and infusion volume, operative time, and extubation time after surgery of those patients in study and contrl group were co-mapared. Results The operative time, preoperative CRP and MMSE of the two groups were similar (P>0.05);While the study group had significantly less intraoperative use of sevoflurane, opioids and less infusion volume, as well as less time to extubation than the control group (P<0.05);Besides, the incidence of postoperative cognitive dysfunction (POCD) was also lower in study group (P<0.05); The levels of CRP1, CRP3, and CRP7 were increased after surgery in both groups, with significant difference observed (P<0.05). Conclusion Management with EARS reduces the incidence of postopera-tive cognitive dysfunction in elderly patients with elective colorectal surgery, which is possibly attributable to the reduced use of general anesthetic and mitigated systemic inflammatory response.%目的：观察加速康复外科所采取的措施能否降低老年人择期结直肠肿瘤手术后认知功能障碍（POCD）的发生率。方法选取接受择期结直肠手术的老年结直肠肿瘤患者共计66例，分为试验组和对照组，试验组患者采用加速康复外科措施，对照组患者采用传统围术期管理措施。比较两组术前和术后第7天的简明精神状态量表（MMSE）评分，术前以及术后第1、3、7天的急性期C反应蛋白（CRP0、CRP1、CRP3、CRP7），术中的七氟烷以及阿片类药物用量、输液量，手术时间以及手术结束到患者清醒拔管时间。结果两组患者手术时间、术前CRP以及MMSE评分比较，差异无统计学意义（P﹥0.05）。试验组患者术中七氟烷使用量、阿片类药物用量、输液量均少于对照组，拔除气管导管时间短于对照组，POCD发生率低于对照组，差异均有统计学意义（P﹤0.05）。两组CRP1、CRP3、CRP7浓度均较同组术前升高，差异有统计学意义（P﹤0.05）。结论采用加速康复外科措施的老年患者，术后认知功能障碍发生率下降，可能与加速康复外科措施中全身麻醉药使用量减少以及术后全身炎性反应较轻有关。