冠状动脉搭桥手术后，执行功能受损与谵妄有关。
Impaired executive function is associated with delirium after coronary artery bypass graft surgery.
作者信息
Rudolph James L, Jones Richard N, Grande Laura J, Milberg William P, King Emily G, Lipsitz Lewis A, Levkoff Sue E, Marcantonio Edward R
机构信息
Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.
出版信息
J Am Geriatr Soc. 2006 Jun;54(6):937-41. doi: 10.1111/j.1532-5415.2006.00735.x.
OBJECTIVES
To determine the extent to which preoperative performance on tests of executive function and memory was associated with delirium after coronary artery bypass graft (CABG) surgery.
DESIGN
Prospective observational cohort study.
SETTING
Two academic medical centers and one Department of Veterans Affairs medical center in Massachusetts.
PARTICIPANTS
Eighty subjects without preoperative delirium undergoing CABG or CABG-valve surgery completed baseline neuropsychological assessments with validated measures of memory and executive function.
MEASUREMENTS
Beginning on postoperative Day 2, a battery to diagnose delirium was administered daily. Confirmatory factor analysis (CFA) was used to define two cognitive domain composites (memory and executive function). The loading pattern of neuropsychological measures onto the latent cognitive domains was determined a priori. Poisson regression was used to model the association between neuropsychological performance and cognitive domain composite scores and risk of postoperative delirium. The association was expressed as the difference between impaired (0.5 standard deviations (SDs) below mean) and nonimpaired (0.5 SDs above mean) performers.
RESULTS
Forty subjects (50%) developed delirium. Measures of memory function were not significantly related to delirium. Of the executive function measures, verbal fluency, category fluency, Hopkins Verbal Learning Test learning, and backward recounting of days and months were significantly related to delirium. Preoperative mental status was a strong predictor of postoperative delirium. After controlling for age, sex, education, medical comorbidity, mental status, and the other cognitive domain, CFA cognitive domain composites suggest that risk for delirium is specific for executive functioning impairment (relative risk (RR) = 2.77, 95% confidence interval (CI) = 1.12-6.87) but not for memory impairment (RR = 0.49, 95% CI = 0.19-1.25).
CONCLUSION
Worse preoperative performance in executive function was independently associated with greater risk of developing delirium after CABG.
目的
确定冠状动脉搭桥术（CABG）后谵妄与术前执行功能和记忆测试表现之间的关联程度。
设计
前瞻性观察队列研究。
地点
马萨诸塞州的两个学术医疗中心和一个退伍军人事务部医疗中心。
参与者
80名无术前谵妄且接受CABG或CABG-瓣膜手术的受试者完成了具有效记忆和执行功能测量的基线神经心理学评估。
测量
从术后第2天开始，每天进行一组用于诊断谵妄的测试。验证性因素分析（CFA）用于定义两个认知领域综合指标（记忆和执行功能）。神经心理学测量在潜在认知领域的加载模式是预先确定的。泊松回归用于模拟神经心理学表现与认知领域综合得分以及术后谵妄风险之间的关联。该关联表示为表现受损（低于均值0.5个标准差（SDs））和未受损（高于均值0.5个SDs）者之间的差异。
结果
40名受试者（50%）出现谵妄。记忆功能测量与谵妄无显著关联。在执行功能测量中，言语流畅性、类别流畅性、霍普金斯言语学习测试学习以及日期和月份的倒叙与谵妄显著相关。术前精神状态是术后谵妄的有力预测因素。在控制了年龄、性别、教育程度、合并症、精神状态和其他认知领域后，CFA认知领域综合指标表明，谵妄风险特定于执行功能障碍（相对风险（RR）=2.77，9
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