心理干预对老年结直肠癌患者术后 认知功能及焦虑的影响

Effect of psychological intervention on postoperative cognitive function and anxiety in elderly patients with colorectal cancer

摘要:

目的 探讨围术期心理干预对老年结直肠癌患者术后认知功能及焦虑的影响。方法 选取全身麻 醉下行结直肠癌手术患者50 例，年龄65 ～ 75 岁，ASA Ⅰ、Ⅱ级，采用随机数字表法分为心理干预组（I 组） 和对照组（C 组），每组25 例。C 组进行常规术前访视和术后随访，I 组于术前、入手术室后、麻醉清醒后、 术后2 d、术后5 d 随访同时进行心理干预。记录术前2 d、入室后静卧5 min、麻醉诱导前即刻、切皮、术中 2 h、术毕、拔管、术后1 d、术后3 d、术后7 d 等10 个时间点的血压（BP）、心率（HR）；记录术前2 d、入 室后静卧5 min、术后7 d、术后2 周的焦虑自评量表（SAS）评分；于术前2 d、麻醉诱导前即刻、术毕、术后1、 2、3 d 收集血液标本，测定神经元特异性烯醇化酶（NSE）含量；于术前2 d、术后1、3、7 d，术后2 周随访登 记简易精神智能状态量表（MMSE）评分、连线测验（TMT）完成时间。结果 与I 组比较，C 组入室后静卧 5 min、术后7 d、术后2 周的SAS 评分升高且差异有统计学意义（P <0.05）；术后1、3、7 d I 组的MMSE 评分 高于C 组，术后1、3、7 d I 组的TMT 完成时间短于C 组，麻醉前诱导前即刻、术毕、术后1、2、3 d I 组NSE 含量低于C 组，术后1、3、7 d C 组POCD 发生率高于I 组，差异均有统计学意义（P <0.05）。结论 围术期 心理干预可改善老年结直肠癌患者焦虑状况，减少认知功能障碍的发生。

Abstract:

Objective To investigate the effect of psychological intervention on postoperative cognitive function and anxiety in elderly patients undergoing surgery for colorectal cancer. Methods Fifty patients undergoing elective colorectal cancer surgery under general anesthesia were selected. They were aged 65-75 years and at ASA grade I-II, and divided into an observation group (group C) and a psychological intervention group (group I) by the random number table method with 25 cases in each group. The patients in the group C underwent routine preoperative visit and postoperative follow-up, and those in the group I received simultaneous psychological intervention before operation, after entering the operation room, after wakefulness, and during follow-up on the 2nd and 5th d after operation. BP and HR were recorded 2 d before operation, 5 min after the patients entering the operating room,immediately before induction of anesthesia, at the time of incision, 2 h after incision, at the end of surgery, at the time of extubation, 1 d after surgery, 3 d after surgery and 7 d after surgery. The score of Self-rating Anxiety Scale (SAS) was recorded 2 d before operation, after entering the operating room, 7 d after surgery and 2 w after surgery. The blood samples were collected from the patients 2 d before operation, 5 min before anesthesia induction, at the end of surgery, and 1, 2 and 3 d after surgery to determine the content of neuron-specific enolase (NSE). The completion time of Mini-mental State Examination (MMSE) score and Trail Making Test (TMT) was recorded 2 d before surgery, and 1, 3 and 7 d and 2 w after surgery. Results Compared with the group I, the SAS score of the group C significantly increased after entering the operating room, 7 d and 2 w after surgery with statistical differences (P < 0.05). Compared with the group I, the MMSE score of the group C was significantly reduced 1, 3 and 7 d after surgery (P < 0.05); and the TMT completion time of the group C was significantly prolonged 1, 3 and 7 d after surgery (P < 0.05). Compared with the group C, the blood level of NSE in the group I was significantly decreased 5 min before induction of anesthesia, at the end of surgery, and 1, 2 and 3 d after surgery (P < 0.05); the incidence of postoperative cognitive dysfunction (POCD) in the group I was significantly decreased 1, 3 and 7 d after surgery (P < 0.05). Conclusions Perioperative psychological intervention can ameliorate anxiety status and reduce cognitive dysfunction in elderly patients undergoing colorectal cancer surgery.