Risk factors and a prognostic model for postoperative cognitive dysfunction after gynecologic laparoscopic surgery in elderly women
10.3760/cma.j.issn.0254-9026.2019.03.011
- VernacularTitle:老年患者妇科腹腔镜术后认知功能障碍相关危险因素及预后模型
- Author:
Cheng LIU
1
;
Ying WANG
;
Li CHEN
;
Jie MENG
;
Shenghua LI
;
Jingli CHEN
;
Hong YAN
Author Information
1. 武汉大学人民医院妇产科 430060
- Keywords:
Cognitive disorders;
Anesthesia;
general;
Risk factor
- From:
Chinese Journal of Geriatrics
2019;38(3):269-273
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors for postoperative cognitive dysfunction (POCD)after gynecologic laparoscopic surgery in elderly female patients,and to establish a risk model for prognosis.Methods Mini-Mental State Examination(MMSE) was used to evaluate the cognitive function of 280 elderly women who underwent gynecologic laparoscopic surgery from April 2014 to March 2016 in four tertiary-level hospitals in Hubei Province.Thirty-two cases were excluded due to withdrawal or loss of follow-up,and 248 cases with complete and valid data were collected for analysis.According to the degree of cognitive impairment on the 7th day after operation,subjects were grouped into a POCD group and a non-POCD group.Logistic regression was used to determine risk factors and establish a prognostic model for POCD.Results Of the 248 subjects enrolled,62 (25.0％) were diagnosed with POCD on the 7th day after operation.Multivariate Logistic regression analysis showed that American Society of Anesthesiologists(ASA) grade(OR =4.578,95％CI:1.156 ～18.139,P =0.030),age (OR =1.465,95％ CI:1.230 ～ 1.745,P =0.000),and duration of anesthesia(OR =1.030,95 ％ CI:1.005 ～ 1.056,P =0.017) were independent risk factors for POCD,and intraoperative administration of dexmedetomidine (OR =0.069,95 ％ CI:0.508 ～ 14.094,P =0.011),dexamethasone (OR =0.135,95 ％ CI:0.200 ～ 0.928,P =0.042),and maintenance of deep anesthesia(OR =0.761,95 ％ CI:0.630 to 0.919,P =0.005) were protective factors.A prognostic model was established based on the principle of logistic regression equation.The receiver operating characteristic(ROC)curve determined Y=4.291 as the best risk value,and the expected sensitivity and specificity were 90.3％ and 97.8％,respectively.Additionally,another 50 independent cases were included to verify the predictive efficacy of the model.It showed that the overall correct rate was 86.0％,and the sensitivity and specificity were 81.8％ and 87.2％,respectively.Conclusions Increased ASA grade,advanced age,prolonged anesthesia time are independent risk factors for POCD,and intraoperative administration of dexmedetomidine,dexamethasone,maintenance of deep anesthesia play a protective role.The prognosis model of POCD has certain clinical value.
