Silbert B S, Maruff P, Evered L A, Scott D A, Kalpokas M, Martin K J, Lewis M S, Myles P S
Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia.
Br J Anaesth. 2004 Jun;92(6):814-20. doi: 10.1093/bja/aeh157. Epub 2004 Apr 2.
Postoperative cognitive decline is a common complication after coronary artery bypass graft (CABG) surgery. Postoperative cognitive decline is defined on the basis of change in cognitive function detected with repeated assessments using neuropsychological tests. Therefore improvement in neuropsychological testing instruments may increase our understanding of postoperative cognitive decline.
Fifty patients undergoing CABG surgery completed both a conventional and a computerized battery of tests before and 6 days after CABG surgery. Fifty age- and education-matched controls completed the same test batteries 6 days apart. The reliability and the sensitivity to postoperative cognitive decline were computed for each battery.
Both test batteries detected postoperative cognitive decline 6 days after CABG surgery. For the computerized battery, the reliability of the reaction times (intraclass correlation 0.89-0.92) was greater than for any test from the conventional battery (intraclass correlation 0.56-0.71), although accuracy measures were less reliable (intraclass correlation 0.61-0.89). The computerized battery detected all the cases of POCD identified by the conventional test battery and also five cases that were classified as normal by the conventional tests.
Computerized tests are suitable for measuring cognitive change after CABG surgery and may detect change in a greater proportion of patients 6 days after CABG surgery than conventional neuropsychological tests.
术后认知功能下降是冠状动脉旁路移植术（CABG）术后常见的并发症。术后认知功能下降是根据使用神经心理学测试进行反复评估所检测到的认知功能变化来定义的。因此，神经心理学测试工具的改进可能会增进我们对术后认知功能下降的理解。
50例行CABG手术的患者在手术前及术后6天完成了一组传统测试和一组计算机化测试。50名年龄和教育程度匹配的对照者在间隔6天的时间里完成了相同的测试组。计算每组测试对术后认知功能下降的可靠性和敏感性。
两组测试均在CABG术后6天检测到术后认知功能下降。对于计算机化测试组，反应时间的可靠性（组内相关系数0.89 - 0.92）高于传统测试组的任何一项测试（组内相关系数0.56 - 0.71），尽管准确性指标的可靠性较低（组内相关系数0.61 - 0.89）。计算机化测试组检测出了传统测试组所识别的所有术后认知功能障碍病例，还检测出了5例传统测试分类为正常的病例。
计算机化测试适用于测量CABG术后的认知变化，并且在CABG术后6天可能比传统神经心理学测试检测到更大比例患者的变化。
