Abildstrom H, Rasmussen L S, Rentowl P, Hanning C D, Rasmussen H, Kristensen P A, Moller J T
Department of Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark.
Acta Anaesthesiol Scand. 2000 Nov;44(10):1246-51. doi: 10.1034/j.1399-6576.2000.441010.x.
Postoperative cognitive dysfunction (POCD) is a well-recognised complication of cardiac surgery, but evidence of POCD after general surgery has been lacking. We recently showed that POCD was present in 9.9% of elderly patients 3 months after major non-cardiac surgery. The aim of the present study was to investigate whether POCD persists for 1-2 years after operation.
A total of 336 elderly patients (median age 69 years, range 60-86) was studied after major surgery under general anesthesia. Psychometric testing was performed before surgery and at a median of 7, 98 and 532 days postoperatively using a neuropsychological test battery with 7 subtests. A control group of 47 non-hospitalised volunteers of similar age were tested with the test battery at the same intervals.
1-2 years after surgery, 35 out of 336 patients (10.4%, CI: 7.2-13.7%) had cognitive dysfunction. Three patients had POCD at all three postoperative test sessions (0.9%). From our definition of POCD, there is only a 1:64000 likelihood that a single subject would have POCD at all three test points by chance. Logistic regression analysis identified age, early POCD, and infection within the first three postoperative months as significant risk factors for long-term cognitive dysfunction. Five of 47 normal controls fulfilled the criteria for cognitive dysfunction 1-2 years after initial testing (10.6%, CI: 1.8-19.4%), i.e. a similar incidence of age-related cognitive impairment as among patients.
POCD is a reversible condition in the majority of cases but may persist in approximately 1% of patients.
术后认知功能障碍（POCD）是心脏手术一种公认的并发症，但普通外科手术后POCD的证据一直缺乏。我们最近发现，9.9%的老年患者在接受非心脏大手术后3个月出现POCD。本研究的目的是调查POCD在术后1至2年是否持续存在。
对336例接受全身麻醉下大手术的老年患者（中位年龄69岁，范围60 - 86岁）进行研究。术前及术后中位时间7天、98天和532天使用包含7个分测验的神经心理测试组合进行心理测量测试。对47名年龄相仿的非住院志愿者组成的对照组在相同时间间隔使用该测试组合进行测试。
术后1至2年，336例患者中有35例（10.4%，CI：7.2 - 13.7%）出现认知功能障碍。3例患者在术后所有三次测试中均出现POCD（0.9%）。根据我们对POCD的定义，单个受试者在所有三个测试点偶然出现POCD的可能性仅为1:
在大多数情况下，POCD是一种可逆的情况，但可能在约1%的患者中持续存在。 64000。逻辑回归分析确定年龄、早期POCD以及术后前三个月内的感染是长期认知功能障碍的重要危险因素。47名正常对照组中有5名在初次测试后1至2年符合认知功能障碍标准（10.6%，CI：1.8 - 19.4%），即与患者中年龄相关认知障碍的发生率相似。
