Hudetz Judith A, Patterson Kathleen M, Byrne Alison J, Pagel Paul S, Warltier David C
Department of Anesthesiology, Medical College of Wisconsin, USA.
Psychol Rep. 2009 Dec;105(3 Pt 1):921-32. doi: 10.2466/PR0.105.3.921-932.
Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients (M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls (M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied (n = 28 Surgery; n = 28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.
心脏手术后经常会出现伴有认知障碍的术后谵妄。据推测,谵妄与使用体外循环手术患者术后残留的认知功能障碍有关。选取年龄在55岁及以上的男性心脏外科手术患者(平均年龄 = 66岁,标准差 = 8;平均受教育年限 = 13年,标准差 = 2)和非手术对照组(平均年龄 = 62岁,标准差 = 7;平均受教育年限 = 12年,标准差 = 2),使其在年龄和受教育程度上达到平衡。术前及术后长达5天通过重症监护谵妄筛查清单评估谵妄情况。在手术前和术后1周评估近期言语和非言语记忆以及执行功能(作为特定测试的分数)。在研究的56名患者中(手术组n = 28;非手术组n = 28),手术组有9名患者出现谵妄。在手术组中,出现谵妄的患者术后认知功能障碍的比例(89%)显著高于未出现谵妄的患者(37%)。出现谵妄的患者发生这种功能障碍的几率是未出现谵妄患者的14倍。术后谵妄与心脏手术后1周的术后残留认知功能障碍评分相关。