Rudolph J L, Schreiber K A, Culley D J, McGlinchey R E, Crosby G, Levitsky S, Marcantonio E R
Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02130, USA.
Acta Anaesthesiol Scand. 2010 Jul;54(6):663-77. doi: 10.1111/j.1399-6576.2010.02236.x. Epub 2010 Apr 15.
Post-operative cognitive dysfunction (POCD) is a decline in cognitive function from pre-operative levels, which has been frequently described after cardiac surgery. The purpose of this study was to examine the variability in the measurement and definitions for POCD using the framework of a 1995 Consensus Statement on measurement of POCD. Electronic medical literature databases were searched for the intersection of the search terms 'thoracic surgery' and 'cognition, dementia, and neuropsychological test.' Abstracts were reviewed independently by two reviewers. English articles with >50 participants published since 1995 that performed pre-operative and post-operative psychometric testing in patients undergoing cardiac surgery were reviewed. Data relevant to the measurement and definition of POCD were abstracted and compared with the recommendations of the Consensus Statement. Sixty-two studies of POCD in patients undergoing cardiac surgery were identified. Of these studies, the recommended neuropsychological tests were carried out in less than half of the studies. The cognitive domains measured most frequently were attention (n=56; 93%) and memory (n=57; 95%); motor skills were measured less frequently (n=36; 60%). Additionally, less than half of the studies examined anxiety and depression, performed neurological exam, or accounted for learning. Four definitions of POCD emerged: per cent decline (n=15), standard deviation decline (n=14), factor analysis (n=13), and analysis of performance on individual tests (n=12). There is marked variability in the measurement and definition of POCD. This heterogeneity may impede progress by reducing the ability to compare studies on the causes and treatment of POCD.
术后认知功能障碍（POCD）是指认知功能较术前水平下降，这在心脏手术后经常被描述。本研究的目的是使用1995年关于POCD测量的共识声明框架，检查POCD测量和定义的变异性。在电子医学文献数据库中搜索“胸外科手术”与“认知、痴呆和神经心理学测试”的搜索词交集。两名评审员独立审查摘要。对1995年以来发表的、有超过50名参与者、对接受心脏手术的患者进行术前和术后心理测量测试的英文文章进行了审查。提取与POCD测量和定义相关的数据，并与共识声明的建议进行比较。确定了62项关于心脏手术患者POCD的研究。在这些研究中，不到一半的研究进行了推荐的神经心理学测试。最常测量的认知领域是注意力（n = 56；93%）和记忆力（n = 57；95%）；运动技能测量较少（n = 36；60%）。此外，不到一半的研究检查了焦虑和抑郁、进行了神经系统检查或考虑了学习因素。出现了POCD的四种定义：下降百分比（n = 15）、标准差下降（n = 14）、因子分析（n = 13）和个体测试表现分析（n = 12）。POCD的测量和定义存在显著变异性。这种异质性可能会降低对POCD病因和治疗研究进行比较的能力，从而阻碍进展。
