王凯元, 刘玲, 李锦成, 唐鹏, 李惠霞, 段晓峰. 新辅助化疗对老年患者单肺通气手术后认知功能障碍的影响[J]. 中国肿瘤临床, 2014, 41(12): 801-805. DOI: 10.3969/j.issn.1000-8179.20140081
引用本文: 王凯元, 刘玲, 李锦成, 唐鹏, 李惠霞, 段晓峰. 新辅助化疗对老年患者单肺通气手术后认知功能障碍的影响[J]. 中国肿瘤临床, 2014, 41(12): 801-805. DOI: 10.3969/j.issn.1000-8179.20140081
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WANG Kaiyuan, LIU Ling, LI Jincheng, TANG Peng, LI Huixia, DUAN Xiaofeng. Effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction in elderly patients after one-lung ventilation surgery[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(12): 801-805. DOI: 10.3969/j.issn.1000-8179.20140081
Citation: WANG Kaiyuan, LIU Ling, LI Jincheng, TANG Peng, LI Huixia, DUAN Xiaofeng. Effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction in elderly patients after one-lung ventilation surgery[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(12): 801-805. DOI: 10.3969/j.issn.1000-8179.20140081
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新辅助化疗对老年患者单肺通气手术后认知功能障碍的影响

Effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction in elderly patients after one-lung ventilation surgery

    摘要
  • 摘要:
      目的   探讨术前新辅助化疗对单肺通气（one lung ventilation，OLV）手术老年患者术后早期认知功能障碍（post-opera-tive cognitive dysfunction，POCD）的影响。
      方法   选取90例行择期食管癌根治术的患者（包括两野淋巴结清扫术和三野淋巴结清扫术），年龄≥60岁，ASA分级Ⅰ~Ⅱ级，肿瘤临床TNM分期Ⅱ~Ⅲ期，随机分为新辅助化疗组（N组）和对照组（C组），每组各45例。患者均分别在术前1 d和术后7 d接受神经心理学测试以评估认知功能改变，根据Z值法判断POCD发生情况。
      结果   N组44例及C组41例术后顺利完成神经心理学测试。两组患者人口统计学资料、肿瘤分期和术中及术后临床资料相比无显著性差异。N组患者术后7 d 21例（47.7%）发生POCD，C组患者术后7 d 11例（26.8%）发生POCD。两者相比差异有统计学意义（χ2=3.949，P=0.047）。
      结论   新辅助化疗会加重老年患者OLV手术术后早期认知功能的损害，显著增加POCD发病率。

     

    Abstract:
      Objective   We aimed to investigate the effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction (POCD) in elderly patients who underwent one-lung ventilation (OLV) surgery.
      Methods   A total of 90 esophageal carcinoma patients aged 60 years old or older were included. These patients were scheduled for esophagectomy, including two or three-field lymphadenectomy, and were randomly divided into two groups based on the American Society of Anesthesiologists status (Ⅰ or Ⅱ) and the Tumor-Node-Metastasis (TNM) classification stage (Ⅱ or Ⅲ), as follows: the neo-adjuvant chemotherapy group (Group N: n=45) that received preoperative neo-adjuvant chemotherapy; and the control group (Group C: n=45) that did not receive chemotherapy. The neuropsychological test was performed 1 d before and 7 d after surgery to evaluate the changes in cognitive function. The incidence of POCD was also determined via the Z-value method in the two groups.
      Results   A total of 44 patients in Group N and 41 patients in Group C completed the neuropsychological tests. No statistical differences were observed in the demographics, TNM stage, and the intra- and post-operative clinical data between the groups. POCD was observed in 21 of the patients in Group N (47.7%) and 11 of the patients in Group C (26.8%), and the differences were significant (χ2=3.949, P=0.047).
      Conclusion   Neo-adjuvant chemotherapy can aggravate the impairment of cognitive function in the elderly patients undergoing OLV surgery and can significantly increase the incidence of POCD.

     

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