老年肺癌根治术后认知功能障碍与患者短期预后的相关性

Correlation between cognitive dysfunction and short-term prognosis in elderly patients with lung cancer after radical surgery

【摘要】目的 探讨老年肺癌根治术后认知功能障碍(POCD)与出院后生活质量的相关性。方法 选择2021年3月至2023年7月首都医科大学附属北京朝阳医院收治的320例行肺癌根治术的老年患者为研究对象,采用蒙特利尔认知评估量表(MoCA)评估患者手术前后的认知功能。根据POCD发生情况将患者分为POCD组(n=58)和非POCD组(n=262),比较两组患者出院后6个月欧洲癌症研究和治疗组织生活质量问卷(EORTC QLQ-C30)评分,分析术后1周MoCA评分与出院后6个月EORTC QLQ-C30评分的相关性。采用SPSS 22.0统计软件进行数据分析。根据数据类型分别采用χ²检验或t检验进行组间比较。采用多因素logistic回归模型分析POCD发生的影响因素。采用Pearson相关系数分析认知功能与生活质量的相关性。结果 术后1周,58例(18.12%)患者发生POCD。术后1周,POCD组MoCA评分低于非POCD组；POCD组麻醉时间、术中出血量及术中局部脑氧饱和度下降最大百分数(rScO₂%max)大于非POCD组；POCD组术中局部脑氧饱和度最小值(rScO₂min)及术后自控镇痛使用率低于非COPD组；出院后6个月,POCD组角色功能、认知功能及总体生活质量评分低于非POCD组,疲劳评分高于非POCD组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,麻醉时间(OR=1.490,95%CI 1.085~2.047)、术中失血量(OR=1.162,95%CI 1.090~2.533)、rScO₂%max(OR=1.533,95%CI 1.094~2.147)及术后自控镇痛使用(OR=0.671,95%CI 0.463~0.972)均为POCD发生的独立影响因素(P<0.05)。Pearson相关性分析显示,老年肺癌根治术后1周MoCA评分与EORTC QLQ-C30量表角色功能、认知功能及总体生活质量维度评分均呈正相关(r=0.319,0.490,0.448；P<0.05)；与疲劳维度评分呈负相关(r=-0.297；P<0.05)。结论 老年肺癌根治术患者术后1周POCD与出院后生活质量密切相关,POCD患者角色功能、认知功能及总体生活质量评分均下降。建议从控制手术麻醉时间、减少术中失血量、术后积极镇痛等方面出发,降低POCD发生风险,提高患者术后生活质量。

基金项目:北京市自然科学基金面上项目(7222070)；国家卫生健康委医药卫生科技发展研究中心课题(WA2021RW35)

【Abstract】Objective To explore the correlation between postoperative cognitive dysfunction (POCD) and quality of life after discharge in the elderly patients with radical resection of lung cancer. Methods From March 2021 to July 2023,320 elderly patients undergoing radical resection of lung cancer in Beijing Chaoyang Hospital of Capital Medical University were selected as the study subjects. Montreal cognitive assessment (MoCA) was used to evaluate the cognitive function of patients before and after surgery. According to the occurrence of POCD, the patients were divided into POCD group (n=58) and non-POCD group (n=262). The European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) scores at six months after discharge were compared between the two groups. The correlation between MoCA scores at one week after surgery and EORTC QLQ-C30 scores at six months after discharge was analyzed. SPSS 22.0 was used for data analysis, and Chi-square test or t test was used for between-group comparison according to the data type. Multivariate logistic regression model was used to analyze the influencing factors of POCD, and Pearson correlation coefficient was used to analyze the correlation between cognitive function and quality of life. Results Among the 320 patients, 58 developed POCD one week after surgery, with an incidence of 18.12%. At one week after surgery, the MoCA score in the POCD group was lower than that in the non-POCD group. Compared with the non-POCD group, the POCD group had significantly longer anesthesia time, more intraoperative blood loss, and higher maximum decrease in regional cerebral oxygen saturation (rSCO₂max) of intraoperative, and had significantly intraoperative lower minimum regional cerebral oxygen saturation (rScO₂min) and postoperative patient-controlled analgesia rate. At six months after discharge, the scores of role function, cognitive function, and overall quality of life were lower but the fatigue score was higher in the POCD group than those in the non-POCD group, and the differences were statistically significant (P<0.05). Multivariate logistic regression model showed that anesthesia time (OR=1.490,95%CI 1.085-2.047), intraoperative blood loss (OR=1.162,95%CI 1.090-2.533), rScO₂%max (OR=1.533,95%CI 1.094-2.147), and postoperative patient-controlled analgesia (OR=0.671,95%CI 0.463-0.972) were independent influencing factors of POCD (P<0.05). Pearson correlation analysis indicated that MoCA score at one week after radical resection in the elderly patients with lung cancer was positively correlated with role function, cognitive function, and overall quality of life in EORTC QLQ-C30 (r=0.319,0.490,0.448; P<0.05), and was negatively correlated with fatigue (r=-0.297; P<0.05). Conclusion POCD at postoperative one week in the elderly patients with radical resection of lung cancer is closely related to the quality of life after discharge with decreased scores of role function, cognitive function, and overall quality of life. It is recommended to reduce the risk of POCD and improve the postoperative quality of life of patients from the aspects of control of surgical anesthesia time, reduction of intraoperative blood loss, and postoperative active analgesia.

This work was supported by the General Program of Beijing Natural Science Foundation (7222070) and the Project of Medicine and Health Technology Development Research Center of National Health Commission (WA2021RW35).