Analysis Of Influencing Factors Of Postoperative Rehabilitation And Quality Of Life In Elderly Patients With Gastrointestinal Tumors

Objective:Find out the relevant influencing factors by observing the changes in the scores of postoperative pain,anxiety,cognition,intelligence and quality of life in elderly patients.Methods:The cases data of 121 elderly patients who underwent elective radical resection of colorectal cancer or radical resection of gastric cancer in the First Affiliated Hospital of Guangxi Medical University from September 2019 to October 2020 were collected.The data was divided in 2 ways,the one is according the different surgical that the patients received as laparotomy group（96 cases）and laparotomy group（25 cases）;the other one is according to the different anesthesia plan as general anesthesia group（group G）（10 cases）,general anesthesia+TAP block group（group GT）（21 cases）,general anesthesia+TAP block+PCVA group（group GTV）（43 cases）,general anesthesia+PCVA group（group GV）（19 cases）,general anesthesia+PCEA group（group GE）（28cases）.Before surgery（Day-0）,Baker Anxiety Scale（BAI）,American Pain Society Patient Outcome Questionnaire（APS-POQ-R）,Visual Analogue Scale（VAS）,Delirium Scale Analysis System（CAM-CR）,Mini-mental State Examination（MMSE）and Quality of Life Scale for tumor patients（Qo L）were applied to assess patients’conditions of anxiety,pain condition,delirium,cognition and quality of life.On the first day（POD-1）,the third day（POD-3）,and the seventh day（POD-7）after surgery,to assess patients’conditions of anxiety,pain condition,delirium and cognition,BAI,APS-POQ-R,VAS,CAM-CR,MMSE scales were applied.In the first month（POD-30）,third month（POD-90）,and six month（POD-180）,to assess patients’conditions of pain and quality of life,ASP-POQ-R score and Qo L scale were applied.Results:1.A total of 121 patients were enrolled in this study,including 88males and 33 females;104 cases between 65 and 75 years old,17 cases between75 and 85 years old;50 cases of farmers,63 cases of retirees,8 cases of freelance work;42 cases of colon cancer,33 cases of rectal cancer,46 cases of gastric cancer;25 cases of laparotomy,96 cases of laparoscopic surgery;10cases of group G,21 cases of group GT,43 cases of group GTV,19 cases of group GV,28 cases of group GE.2.Scale scores under different surgical methods:（1）BAI score:compared with Day-0,the scores have no statistical difference in the laparotomy group on POD-1 and POD-3（P?0.05）,and the score on POD-7 was lower（P?0.05）,the scores have no statistical difference in the laparoscopic group on POD-1（P?0.05）,on POD-3 and POD-7 the scores reduced（P?0.05）;compared with POD-1,scores have no statistical difference in the laparotomy group on POD-3（P?0.05）,the score decreased on POD-7（P?0.05）,scores in the laparoscopic group decreased on POD-3 and POD-7（P?0.05）;compared with POD-3,scores in the laparotomy group and the laparoscopic group decreased on POD-7（P?0.05）.（2）VAS score:compared with Day-0,the scores of the laparotomy group and the laparoscopic group were increased on POD-1,POD-3 and POD-7（P?0.05）;compared with POD-1,the scores of the laparotomy group and the laparoscopic group were decreased on POD-3 and POD-7（P?0.05）;compared with POD-3,the scores of the laparotomy group and the laparoscopy group decreased on POD-7（P?0.05）.（3）APS-POQ-R pain score:compared with Day-0,the scores of the laparotomy group and the laparoscopy group increased,form POD-1 to POD-180（P?0.05）;compared with POD-1,the scores of the laparotomy group and the laparoscopy group decreased,form POD-3 to POD-180（P?0.05）;compared with POD-3,the scores of laparotomy group decreased form POD-30 to POD-180,the scores of endoscopic group decreased,form POD-7 to POD-180（P?0.05）;compared with POD-7,the scores of the laparotomy group and the laparoscopy group decreased,from POD-30 to POD-180（P?0.05）;compared with POD-30,the scores of the laparotomy group and the laparoscopy group decreased,from POD-90 to POD-180（P?0.05）;compared with POD-90,the scores of the laparotomy group and the laparoscopy group decreased on POD-180（P?0.05）.（4）CAM-CR score:compared with Day-0,the scores of the laparotomy group and the laparoscopy group increased on POD-1,POD-3 and POD-7（P?0.05）;compared with POD-3,the score of the laparotomy group decrease on POD-7（P?0.05）.（5）MMSE score:compared with Day-0,the scores of the laparoscopy group increased on POD-1,POD-3 and POD-7（P?0.05）;compared with POD-1,the score has no statistical difference of the laparoscopy group on POD-3（P?0.05）,the scores of the laparoscopy group increased on POD-7（P?0.05）;compared with POD-3,the score of the laparoscopy group increased on POD-7（P?0.05）;the scores has no statistical difference at each time point of the laparotomy group（P?0.05）.（6）Qo L score:compared with Day-0,the scores of the laparotomy group and the laparoscopy group decreased on POD-30（P?0.05）,and the scores of the laparoscopy group increased on POD-180（P?0.05）;compared with POD-30,The scores of in the laparotomy group and the laparoscopy group increased,from POD-90 to POD-180（P?0.05）;compared with POD-90,the scores in the laparotomy group and the laparoscopy group increased on POD-180（P?0.05）.3.Scale scores under different anesthesia schemes:（1）APS-POQ-R score:Compared with group G,patients in other groups have lower APS-POQ-R score（P?0.05）;compared with group GT,patients in group GTV have lower APS-POQ-R score（P?0.05）.（2）VAS score:compared with group G,patients in other groups have lower VAS score（P?0.05）;compared with group GT,patients in group GTV and group GE have lower VAS score（P?0.05）;compared with group GV,patients in group GTV and group GE have a lower VAS score（P?0.05）;（3）CAM-CR score:compared with group G,patients in group GTV have a lower CAM-CR score（P?0.05）;compared with group GV,patients in group GTV and group GE have a lower CAM-CR score（P?0.05）;（4）Qo L scores:compared with group G,patients in group GV,group GTV and group GE have a higher Qo L score（P?0.05）;compared with group GT,patients in group GTV and group GE have a higher Qo L score（P?0.05）.4.Correlation analysis:（1）The operation time,the anesthesia time,APS-POQ-R score,VAS score are positively correlated with the patient’s BAI score(P?0.05,r_ot=0.201,r_at=0.196,r _APS=0.233,r _VAS=0.214);the meaningful Single-factor variables were put in the multivariate regression analysis,and the duration of anesthesia was an independent factor affecting the BAI score,that is,the longer the anesthesia time,the more severe the postoperative anxiety（P?0.05）.（2）Age,APS-POQ-R score,VAS score are positively correlated with the patient’s BAI score(P?0.05,r_age=0.278,r _APS=0.216,r _VAS=0.226);the meaningful Single-factor variables were put in the multivariate regression analysis,age was an independent factor affecting the CAM-CR score,that is,the older the patient,the more serious postoperative delirium（P?0.05）.（3）Anesthesia plan,BAI score,APS-POQ-R score,VAS score and patient Qo L score are correlated(P?0.05,r_ap=0.257,r _BAI=0.-276,r _APS=-0.277,r _VAS=-0.325);the meaningful Single-factor variables were put in the multivariate regression analysis,BAI score and VAS score are independent factors that affect Qo L score,that is,the higher the patient’s BAI score and VAS score,the worse the postoperative quality of life（P?0.05）.Conclusion:（1）Different surgical methods have obvious effects on postoperative pain of patients.（2）The longer the anesthesia time of the patient,the more severe the anxiety;the older the patient,the higher the delirium score;the more severe the pain condition and anxiety of the patient,the worse the quality of life.（3）Compared with total intravenous anesthesia,the use of multimodal analgesia（MMA）is easier for patients to recover after surgery.