Study of the correlation between duration of one-lung ventilation and postoperative cognitive dysfunction in elderly patients

ZHOU Nina; WEN Xiaolin; BIAN Jiang; ZHANG Ying

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Study of the correlation between duration of one-lung ventilation and postoperative cognitive dysfunction in elderly patients

更新时间：2023-04-14

- Study of the correlation between duration of one-lung ventilation and postoperative cognitive dysfunction in elderly patients
- Journal of Southwest Medical University Vol. 43, Issue 5, Pages: 473-477(2020)
- 作者机构：
  
  1. 自贡市第一人民医院麻醉科
  2. 西南医科大学附属中医医院麻醉科
- 作者简介：
- 基金信息：
- DOI：
  CLC： R614
- Published：2020，
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[1]周妮娜,温小林,边疆,张英.单肺通气时间与老年患者术后认知功能障碍的相关性研究[J].西南医科大学学报,2020,43(05):473-477.

ZHOU Nina, WEN Xiaolin, BIAN Jiang, et al. Study of the correlation between duration of one-lung ventilation and postoperative cognitive dysfunction in elderly patients. [J]. Journal of Southwest Medical University 43(5):473-477(2020)
[1]周妮娜,温小林,边疆,张英.单肺通气时间与老年患者术后认知功能障碍的相关性研究[J].西南医科大学学报,2020,43(05):473-477. DOI：

ZHOU Nina, WEN Xiaolin, BIAN Jiang, et al. Study of the correlation between duration of one-lung ventilation and postoperative cognitive dysfunction in elderly patients. [J]. Journal of Southwest Medical University 43(5):473-477(2020) DOI：

摘要

目的:单肺通气被认为是导致术后认知功能障碍（postoperative congnitive dysfunction

POCD）的危险因素之一

但单肺通气与POCD是否存在时间效应不得而知。因此

本研究拟探讨单肺通气时间与胸科手术老年患者POCD的相关性。方法:选择2018年10月至2019年10月西南医科大学附属中医医院拟行胸科手术的老年患者198例

按照手术过程中单肺通气的时间分为4组

即:单肺通气时间≤1 h（A1组）、1 h<单肺通气时间≦2 h（A2组）、2 h<单肺通气时间≦3 h（A3组）、单肺通气时间> 3 h（A4组）。于术前1 d、术后7 d两个时间点

采用认知功能评价工具对所有患者的认知功能进行评估

包括简易精神状态量表（mini-mental state examination

MMSE、数字广度及符号测试、循迹连线试验A、词汇流畅性测试及单词辨认测试评分）

然后再根据Z评分法计算各组患者POCD发生情况

分析有差异的评价指标与单肺通气时间的相关性。结果:最终164例患者完成该项研究

其中A1组37例、A2组51例、A3组53例、A4组23例

四组患者术前的一般资料和认知功能比较

差异无统计学意义（P> 0.05）。于术后7 d

发生POCD的患者有51例

总发生率为31.10%;其中

A1组4例（10.81%）、A2组11例（21.57%）、A3组23例（43.40%）、A4组13例（56.52%）

四组之间POCD发生率比较

差异有统计学意义（P <0.05）;相比于A1、A2组患者

A3、A4组术后7 d POCD发生率明显增加（P <0.05）。此外

A3、A4组患者在术后7 d的MMSE评分、数字广度及符号测试评分、词汇流畅性测试评分均较A1、A2组明显降低（P <0.05）。将上述四项指标与单肺通气时间进行Pearson相关性分析

结果提示MMSE量表评分及词汇流畅性测试评分与术中单肺通气时间均呈负相关性（P <0.05）。结论:胸科手术患者术中单肺通气是POCD的危险因素

且随着单肺通气时间越长

患者POCD发生率越高。

Abstract

Objective: One-lung ventilation（OLV） is considered to be one of the risk factors for postoperative cognitive dysfunction（POCD）. However

it is unknown whether there is time effect between OLV and POCD. Therefore

this study aims to explore the correlation between duration of OLV and POCD in elderly patients undergoing a thoracic surgery. Methods: A total of 198 elderly patients who were scheduled to undergo a thoracic surgery in the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from October 2018 to October2019 were selected. According to the intraoperative duration of OLV

the patients were divided into four groups:group A1（duration of OLV ≤ 1 h）

group A2（1 h < duration of OLV ≤ 2 h）

group A3（2 h < duration of OLV ≤ 3 h）

and group A4（duration of OLV > 3 h）. At 1 day before surgery and 7 days after surgery

the cognitive function of all the patients was assessed using cognitive assessment tools including Mini-Mental State Examination（MMSE）

Digit Span and Symbol Test（DSST）

Trail Making Test A（TMTA）

vocabulary fluency test（VFT）

and word recognition test（WRT）. The Z score was calculated to assess the incidence of POCD in each group

and indices of significant differences were analyzed to evaluate their correlation with the duration of OLV. Results: A total of 164 patients（37 in group A1

51 in group A2

53 in group A3

and 23 in group A4） completed the study. There were no significant differences in preoperative general information and cognitive function between the four groups（P > 0.05）. At 7 days after surgery

POCD occurred in 51 patients（31.10%）

including 4（10.81%） in group A1

11（21.57%） in group A2

23（43.40%） in group A3

and 13（56.52%） in group A4. There were significant differences in the incidence of POCD between the four groups（P < 0.05）. The incidence of POCD in groups A3 and A4 was significantly higher than that in groups A1 and A2（P < 0.05）. In addition

at 7 days after surgery

groups A3 and A4 had significantly reduced MMSE

DSST

and VFT scores

as compared with groups A1 and A2（P < 0.05）. An analysis of Pearson correlation between the above four indices and the duration of OLT indicated that MMSE and VFT scores were negatively correlated with the duration of OLV（P < 0.05）. Conclusion: Intraoperative OLV is a risk factor for POCD in patients undergoing a thoracic surgery; the longer the duration of OLV

the higher the incidence of POCD.

关键词

胸科手术POCD危险因素单肺通气时间

Keywords

Thoracic surgeryPostoperative cognitive dysfunctionRisk factorDuration of one-lung ventilation

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