目的 探讨术前新辅助化疗对老年直肠癌患者术后神经认知功能恢复延迟(DNR)的影响。方法 选择2021-07至2023-06在天津市人民医院收治的拟在全麻下择期行直肠癌手术的年龄65岁以上患者173例,根据术前是否行新辅助化疗(NACT)分为术前NACT组(C组)和术前非NACT组(N组),分别在术前1 d及术后30 d内使用神经心理学测试评估患者的认知功能,观察C组和N组患者DNR发生情况,通过Logistic回归分析术后发生DNR的独立危险因素。结果 两组均完成全部相关神经心理学测试。与N组比较,C组术后1 d和3 d的简易智能精神状态检查量表(MMSE)评分和蒙特利尔认知评估量表(MoCA)评分均降低,疼痛视觉模拟评分(VAS)升高(P＜0.05)。C组DNR发生率(55.3%)高于N组(31.8%)(P＜0.05)。与 N 组比较,C 组术后30 d认知功能电话问卷(TICS-m)评分更低(P＜0.05),但两组DNR 发生率差异无统计学意义(P＞0.05)。结论 术前新辅助化疗可导致老年直肠癌患者术后DNR发生率升高,痛觉更为敏感。
Abstract
Objective To investigate the effect of preoperative neoadjuvant chemotherapy on delayed neurocognitive recovery (DNR) in elderly patients with rectal cancer. Methods A total of 173 patients over 65 years old who were admitted to Tianjin People's Hospital from July 2021 to June 2023 for rectal cancer undergoing elective surgery under general anesthesia were selected and divided into preoperative NACT group (group C) and preoperative non-NACT group (group N) according to whether they received neoadjuvant chemotherapy (NACT) before surgery. A series of neuropsychological tests were used to evaluate the cognitive function of the patients 1 day before operation and 30 days after operation. The occurrence of DNR in patients was observed, and the independent risk factors of DNR after surgery were analyzed by multivariatebinary logistic regression. Results Both groups completed all relevant neuropsychological tests. Compared with group N, the MMSE score and MoCA score of group C were lower 1 and 3 days after surgery,and the VAS score of group C was higher (P＜0.05). The incidence of DNR in group C (55.3%) was significantly higher than that in group N (31.8%) (P＜0.05).On the 30th day after surgery, compared with the neuropsychological test in group N, the score of the TICS-M assessment in the C group was lower (P＜0.05),but there was no significant difference in the incidence of DNR of the two groups. Conclusions Preoperative neoadjuvant chemotherapy can increase the incidence of DNR and sensitiveness to pain in elderly patients with rectal cancer.
关键词
老年 /
直肠癌 /
术前新辅助化疗 /
神经认知功能恢复延迟
Key words
elderly /
rectal cancer /
preoperative neoadjuvant chemotherapy /
delayed neurocognitive recovery
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基金
天津麻醉科研发展计划(TJMZ2021-007)
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