[术前化疗对老年肿瘤患者术后早期认知功能障碍的影响]

[Effect of chemotherapy preoperatively upon early postoperative cognitive dysfunction in eldly tumor patients].

作者信息

Fang Jun, Cai Shu-Nv, Jiang Hui-Fang, Zhou Hui-Dan, Lian Yan-Hong

机构信息

Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou 310022, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Sep 8;89(33):2319-23.

PMID:20095352

Abstract

OBJECTIVE

To investigate whether preoperative chemotherapy history could influence the incidence of early postoperative cognitive dysfunction (POCD) in elderly tumor patients.

METHODS

A total of 107 tumor patients (> or = 60 years old, tumor TNM stages T2 - T3, N0 - N3, ASA I -III class) undergoing elective radical surgery of gastric or colorectal cancer were selected and assigned into two groups according to preoperative chemotherapy history: with preoperative chemotherapy history group (C group, n = 52) and without preoperative chemotherapy history group (N group, n = 55). Patients in two groups received radical surgery under intravenous-inhalation general anesthesia combined with epidural anesthesia. Cognitive function was assessed using a battery of neuropsychological tests from five aspects including memory, verbal intelligence, visual-motor, executive function and motor function at 1 day preoperatively and 3 days postoperatively.

RESULTS

There was no significant difference in general state of patient preoperatively health including sex ratio, body mass index, complications, cancer types and stages, ASA classification between two groups (P > 0.05). Neither significant difference was found in duration of anesthesia and surgery, intra-operative bleeding volume and transfusion volume between two groups (P > 0.05). There was no significant difference in ICU admission rate, ICU stay, incidence of complications, hospitalization duration and mortality rate between two groups (P > 0.05). Preoperative neuropsychological test score in group C was slightly lower than that in group N, but the difference was not significant (P > 0.05). Impaired incidence rate of digit-symbol substitution test, controlled oral word association test, grooved pegboard non-dominant hand test and semantic fluency test at 3 days postoperation in group C were significantly higher than those in N group (P < 0.05). Incidence of POCD at 3 days postoperation in group C was significantly higher than that in group N (42.3% vs 15.4% , P < 0.05).

CONCLUSION

Chemotherapy preoperatively could increase the incidence of early postoperative cognitive dysfunction in elderly with tumor.

摘要

目的

探讨术前化疗史是否会影响老年肿瘤患者术后早期认知功能障碍（POCD）的发生率。

方法

选取107例择期行胃癌或结直肠癌根治术的肿瘤患者（年龄≥60岁，肿瘤TNM分期为T2 - T3、N0 - N3、ASA I - III级），根据术前化疗史分为两组：有术前化疗史组（C组，n = 52）和无术前化疗史组（N组，n = 55）。两组患者均在静吸复合全麻联合硬膜外麻醉下行根治性手术。术前1天和术后3天采用包括记忆、语言智力、视运动、执行功能和运动功能五个方面的一系列神经心理学测试评估认知功能。

结果

两组患者术前健康总体状况，包括性别比例、体重指数、并发症、癌症类型和分期、ASA分级等方面差异无统计学意义（P > 0.05）。两组患者麻醉和手术时间、术中出血量及输血量差异均无统计学意义（P > 0.05）。两组患者ICU入住率、ICU停留时间、并发症发生率、住院时间及死亡率差异均无统计学意义（P > 0.05）。C组术前神经心理学测试评分略低于N组，但差异无统计学意义（P > 0.05）。术后3天，C组数字符号替换测验、可控口语联想测验、凹槽钉板非优势手测验及语义流畅性测验的受损发生率均显著高于N组（P < 0.05）。C组术后3天POCD发生率显著高于N组（42.3% 对15.4%，P < 0.05）。