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目的:研究经尿道前列腺电切(transurethral resection of prostate,TURP)术后并发认知功能障碍(post-operation cognitive dysfunction,POCD)的高危因素和防治方法。方法:收集2005年7月～2009年11月TURP病例1052例,回顾性分析发生POCD病例66例。评价指标:年龄,国际前列腺症状评分(IPSS),体质指数(BMI),有否心肺合并症,美国麻醉学会(ASA)评分,前列腺体积,平均手术时间,麻醉方式(全麻,硬膜外麻醉),围手术期是否输血,短期是否二次手术,有否精神类疾病或其药物史。采用卡方检验和非条件Logistic回归多因素分析。结果:高龄(>73岁),IPSS>26分,ASAⅡ级以上,前列腺体积(重量≥40g),手术时间≥46min,有合并心肺疾病,有精神相关疾病和服相关药物史,麻醉方式为全麻,和急需短期二次手术等有统计学意义(P<0.05)。BMI,围手术期是否输血无统计学意义(P>0.05)。多因素Logistic回归分析(β,OR值,P值):麻醉方式(2.234,7.082,0.000),有精神类疾病或其服药史(2.012,5.314,0.001),年龄(1.473,2.426,0.012),ASA评分(0.685,3.403,0.003),手术时间(0.538,2.005,0.019)有统计学意义(P<0.05)。结论:TURP术后并发POCD的高危因素包括高龄、ASA分级、手术时间、麻醉方式(全麻)、有无精神相关疾病或其服药史(P<0.05)。POCD相关因素筛选有助于提高早期诊断率,及时处理,防止继发其他并发症发生。
Objective: To study the risk factors and prevention and treatment of post-operation cognitive dysfunction (POCD) after transurethral resection of prostate (TURP). Methods: 1052 cases of TURP were collected from July 2005 to November 2009, and 66 cases of POCD were retrospectively analyzed. Evaluation criteria: Age, International Prostate Symptom Score (IPSS), Body Mass Index (BMI), Cardiopulmonary Complications, ASA Score, Prostate Volume, Mean Operative Time, Mode of Anesthesia (General Anesthesia, Epidural Anesthesia ), Perioperative blood transfusion, short-term secondary surgery, whether there is a mental illness or drug history. Chi-square test and non-conditional Logistic regression multivariate analysis. Results: Age (> 73 years old), IPSS> 26 points, ASA level Ⅱ, prostate volume (weight ≥40g), operation time ≥46min, with cardiopulmonary disease, mental illness and service related drug history, anesthesia for general anesthesia , And urgently needed short-term secondary surgery and other statistically significant (P <0.05). BMI, perioperative blood transfusion was not statistically significant (P> 0.05). Multivariate logistic regression analysis showed that there was a significant difference in the incidence of psychiatric diseases or their medication history (2.012, 5.314, 0.001), age (1.473, 2.426, 0.012) ASA score (0.685,3.403,0.003), operation time (0.538,2.005,0.019) was statistically significant (P <0.05). Conclusion: The risk factors for POCD complicated with TURP include age, ASA classification, operation time, anesthesia (general anesthesia), mental illness or medication history (P <0.05). Screening for POCD-related factors can help improve the early diagnosis rate, timely treatment, to prevent the occurrence of secondary complications.