摘要
目的探讨老年肺癌根治术中脑组织氧饱和度(SctO_(2))与术后神经认知障碍(PNCD)的相关性。方法选择120例接受肺癌根治术的老年患者,根据PNCD的发生情况将其分为PNCD组、非PNCD组,比较2组患者不同时间点的SctO_(2)水平。采用受试者工作特征(ROC)曲线分析术中SctO_(2)对患者出现PNCD的预测价值。采用Logistic回归模型分析老年肺癌根治术后出现PNCD的危险因素。结果2组患者麻醉前、麻醉后手术开始前SctO_(2)水平比较,差异无统计学意义(P>0.05)。PNCD组患者手术开始30 min及60 min的SctO_(2)水平低于非PNCD组(P<0.05)。ROC曲线显示,手术开始30 min SctO_(2)水平预测患者出现PNCD的最佳截断值为63.29%,曲线下面积为0.812(95%CI0.718~0.906),灵敏度和特异度分别为71.43%、65.22%;手术开始60 min SctO_(2)水平预测患者出现PNCD的最佳截断值为62.35%,曲线下面积为0.822(95%CI0.722~0.923),灵敏度和特异度分别为76.84%、69.57%。Logistic回归模型分析结果显示年龄>70岁、麻醉时间及手术时间较长、超敏C反应蛋白(hs-CRP)水平较高、手术开始30 min SctO_(2)<63.29%、手术开始60 min SctO_(2)<62.35%是患者出现PNCD的独立危险因素(P<0.05)。结论术中SctO_(2)水平较低是PNCD发生的独立危险因素之一,其水平可用于预测老年肺癌根治术后出现PNCD的情况。
Objective To investigate the correlation between intraoperative cerebral oxygen saturation(SctO_(2))and postoperative neuro-cognitive dysfunction(PNCD)in elderly lung cancer patients underwent radical resection.Methods A total of 120 elderly patients with lung cancer underwent radical resection were divided into the PNCD group and non-PNCD group according to the occurrence of PNCD.SctO_(2) levels of two groups at different time points were compared.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of intraoperative SctO_(2) level to the occurrence of PNCD.Logistic regression model was used to analyze the risk factors of the occurrence of PNCD for elderly lung cancer patients after radical resection.Results There was no significant difference in SctO_(2) level between the two groups before anesthesia or after anesthesia before operation(P>0.05).The SctO_(2) levels in the PNCD group at 30 minutes and 60 minutes in the operation were lower than those in the non-PNCD group(P<0.05).ROC curve showed that the best cut-off value of SctO_(2) level to predict the occurrence of PNCD at 30 minutes in the operation was 63.29%,the area under the curve was 0.812(95%CI:0.718 to 0.906),the sensitivity and specificity were 71.43%and 65.22%respectively;the best cut-off value of SctO_(2) level for predicting the occurrence of PNCD at 60 minutes in the operation was 62.35%,the area under the curve was 0.822(95%CI:0.722 to 0.923),the sensitivity and specificity were 76.84%and 69.57%respectively.Logistic regression analysis model showed that age>70 years old,long anesthesia time and operation time,high level of high-sensitive C-reactive protein(hs-CRP),SctO_(2) level at 30 minutes in the operation<63.29%and SctO_(2) level at 60 minutes in the operation<62.35%were the independent risk factors for the occurrence of PNCD in patients(P<0.05).Conclusion Low level of intraoperative SctO_(2) is one of the independent risk factors for the occurrence of PNCD,which can be used to predict the occurrence of PNCD for elderly lung cancer patients after radical resection.
作者
赵德彩
孙玉红
刘伟
ZHAO De-cai;SUN Yu-hong;LIU Wei(Department of Anesthesiology,Bozhou People’s Hospital,Bozhou Anhui 236800,China)
出处
《局解手术学杂志》
2021年第11期947-951,共5页
Journal of Regional Anatomy and Operative Surgery
基金
安徽省自然科学基金项目(1508095MH127)。
关键词
肺癌根治术
术中脑组织氧饱和度
术后神经认知障碍
预测
老年
单肺通气
radical resection for lung cancer
intraoperative cerebral oxygen saturation
postoperative neuro-cognitive dysfunction
prediction
elderly
one-lung ventilation
