The Study Of Risk Factors And Chinese Medicine Syndromes Of Early Postoperative Cognitive Dysfunction In Elderly Patients With Colorectal Cancer

Object ivesTo analyze the incidence and correlative risk factors of postoperative cognitive dysfunction (POCD) in elderly patients undergoing colorectal cancer surgery, and approach the changes of postoperative serum S-100βprotein release to the incidence of POCD. And observe the distribution of the chinese medicine syndrome of POCD, evaluate the relationship between serum S-100βprotein and the chinese medicine syndrome of POCD, provide a theoretical basis to the standardization of chinese medicine syndrome of POCD reserch.Methods166 patients older than 65 years undergoing the surgical removal of colorectal cancer were studied, among then,120 patients completed the study successfully. The cognitive function of the patients was assessed at day 1 before and days 1,3, or 7 after operation using Mini-Mental State examination(MMSE), the incidence was obversed, and multivariate logistic regression analysis were used to examine the relations between perioperative risk factors and POCD. Serum S-100βprotein were measured preoperation, at the end of surgery,24, and 48h postoperatively. To evaluate the relationship between serum S-100βprotein and POCD. The proposed "postoperative cognitivedysfunction syndrome differentiation scale" was used to study the chinese medicine syndrome of POCD. And evaluate the relationship between serum S-100βprotei and the chinese medicine syndrome of POCD.Results The results showed that POCD was present in 35 of the 120 patients at one week after surgery. Logistic regression analysis showed that old age was the significant risk factors for POCD(P＜0.01). The relevance was obversed between the educational level, diabetes and the time of hypotension during operation with the occurrence about the POCD (P<0.05); The patients with the syndrome of TCM were not the factors influencing the morbidity of POCD(P >0.05).There was no significant difference in the level of serum S-100βprotein at preoperation between POCD group and NPOCD group (P＞0.05). The highest level of serum S-100βprotein of POCD group appeared at the end of surgery, compared with the preoperation, there was significant statistic differences (P＜0.01). It was lower at 24 and 48 postoperatively than it at the end of operation, but significantly higher than it at preoperation (P＜0.05). The level of serum S - 100βprotein of NPOCD group at the end of operation is significiantly higher than it at preoperation(P<0.01). The level of serum S- 100βprotein of POCD group at the end of operation was significiantly higher than the NPOCD group(P＜0.01). There were no significiant differences in it between the two groups at 24 and 48 postoperatively(P>0.05).In 35 patients with POCD, the cases of Shenjingkuixu, Tanzhuozuqiao, Yuxuezuluo, Fuzhizhuoliu and Qixuekuixu were 10,12,3,2 and 8 respectively. Serum S-100βincreased at the end of surgery significantly after operation in any syndromes of TCM(P<0.05). The relationship between serum S-100βprotein and the chinese medicine syndromes of POCD was not significant(P＞0.05).ConclusionThe overall incidence of POCD in our study was 29.6%. Age was a significantly risk factor to POCD. The educational level, diabetes and the time of hypotension during operation can affect the occurrence of POCD. Risk factors of POCD include ages more than 70 years, the educational level less than Primary education diabetesandthe time of hypotension during operation more than 10 minutes.The serum S-100βprotein at the end of operation was significiantly higher than it at preoperation In elderly patients undergoing colorectal cancer surgery. The serum S -100βprotein was related to POCD and keep higher at the end of surgery in patients with POCD. It may act as an indicator to evaluate POCD in elderly undergoing colorectal cancer surgery.The distribution of the chinese medicine syndrome of POCD were Shenjingkuixu, Tanzhuozuqiao, Yuxuezuluo, Fuzhizhuoliu and Qixuekuixu respectively. The most cases of POCD rounds at the Shenjingkuixu, Tanzhuozuqiao, and Qixuekuixu. The serum S-100βprotein increased at the end of surgery significantly after operation in any syndromes of TCM, But the relationship between the serum S-100βprotein and the chinese medicine syndromes of POCD was not obversed.