Relationship between intracranial pressure and neurocognitive function among older adults after radical resection of rectal cancer.

IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY World Journal of Gastrointestinal Surgery Pub Date : 2024-10-27 DOI:10.4240/wjgs.v16.i10.3261
Bo Song, Li-Ping Li, Xiao-Lin Wang, Yong Guo, Jun Li
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Abstract

Background: Older patients are prone to postoperative cognitive decline after laparoscopic rectal cancer surgery, which may be associated with increased intraoperative intracranial pressure (ICP). This study investigated the correlation between intraoperative ICP changes, as indicated by measurements of the optic nerve sheath diameter (ONSD) using ultrasonography, and subsequent cognitive function to provide better patient care.

Aim: To evaluate changes in ICP and associated postoperative neurocognition in older adults after laparoscopic radical resection for rectal cancer.

Methods: We included 140 patients who visited the Mianyang Central Hospital for malignant rectal tumors, measured their ONSDs before surgery and 30 and 60 minutes after the Trendelenburg position during surgery, and evaluated the patients' cognitive function 1 day before surgery and 1, 4, and 7 days after surgery. The Mini-Mental State Examination (MMSE) and confusion assessment method (CAM) scores of the patients with different ONSDs were compared at different times after surgery.

Results: In patients with an ONSD greater than 5.00 mm (group A1), the MMSE scores at 1 day and 4 days after surgery were significantly lower than those of patients with an ONSD less than or equal to 4.00 mm (group A2) (P < 0.05). The CAM scores of group A1 were significantly higher than those of group A2 (P < 0.05). The MMSE scores of group A1 on days 1 and 4 after surgery were significantly lower than those 1 day before and 7 days after surgery (P < 0.05), while the CAM scores 1 day and 4 days after surgery were significantly higher than those 1 day before and 7 days after surgery.

Conclusion: Decline in cognitive function among older adults after the procedure may be related to intracranial hypertension during surgery.

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直肠癌根治术后老年人颅内压与神经认知功能之间的关系。
背景:老年患者在腹腔镜直肠癌手术后容易出现术后认知功能下降,这可能与术中颅内压(ICP)升高有关。本研究通过使用超声波测量视神经鞘直径(ONSD)来了解术中ICP变化与术后认知功能之间的相关性,从而为患者提供更好的治疗。目的:评估老年人腹腔镜直肠癌根治术后ICP的变化及相关的术后神经认知:方法:我们纳入了到绵阳市中心医院就诊的140名恶性直肠肿瘤患者,测量了他们术前、术中Trendelenburg体位后30分钟和60分钟的ONSD,并评估了患者术前1天、术后1天、4天和7天的认知功能。比较了不同ONSD患者在术后不同时间的迷你精神状态检查(MMSE)和混淆评估法(CAM)得分:ONSD 大于 5.00 mm 的患者(A1 组)术后 1 天和 4 天的 MMSE 评分明显低于 ONSD 小于或等于 4.00 mm 的患者(A2 组)(P < 0.05)。A1 组的 CAM 评分明显高于 A2 组(P < 0.05)。A1组术后第1天和第4天的MMSE评分明显低于术前1天和术后7天(P < 0.05),而术后第1天和第4天的CAM评分明显高于术前1天和术后7天:结论:老年人术后认知功能下降可能与手术过程中的颅内高压有关。
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