术前存在的认知障碍与髋关节置换术后的认知功能障碍相关。
Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery.
作者信息
Silbert Brendan, Evered Lisbeth, Scott David A, McMahon Stephen, Choong Peter, Ames David, Maruff Paul, Jamrozik Konrad
机构信息
From the Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Victoria, Australia (B.S., L.E., D.A.S.); Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia (B.S., L.E., D.A.S.,); Department of Surgery, Monash University, Melbourne, Victoria, Australia (S.M.); Malabar Orthopaedic Clinic, Windsor, Victoria, Australia (S.M.); Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia (P.C.); Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia (P.C.); Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia (D.A.); National Aging Research Institute, Parkville, Victoria, Australia (D.A.); Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia (P.M.); and School of Population Health, University of Adelaide, Adelaide, South Australia, Australia (K.J.).
出版信息
Anesthesiology. 2015 Jun;122(6):1224-34. doi: 10.1097/ALN.0000000000000671.
BACKGROUND
This study investigated the prevalence of cognitive impairment in elderly noncardiac surgery patients and any association between preoperative cognitive impairment and postoperative cognitive dysfunction (POCD). Additionally, the incidence of cognitive decline at 12 months after surgery was identified.
METHODS
Three hundred patients for hip joint replacement and 51 nonsurgical controls aged 60 yr or older were studied in a prospective observational clinical trial. All study participants and controls completed a battery of eight neuropsychological tests before surgery and at 7 days, 3 months, and 12 months afterwards. Preoperative cognitive status was assessed using preexisting cognitive impairment (PreCI) defined as a decline of at least 2 SD on two or more of seven neuropsychological tests compared to population norms. POCD and cognitive decline were assessed using the reliable change index utilizing the results of the control group.
RESULTS
PreCI was classified in 96 of 300 (32%) patients (95% CI, 23 to 43%). After surgery, 49 of 286 (17%) patients (95% CI, 13 to 22%) and 27 of 284 (10%) patients (95% CI, 6 to 13%) demonstrated POCD at 7 days and 3 months, respectively, while 7 of 271 (3%) patients (95% CI, 1 to 4%) demonstrated cognitive decline at 12 months. Patients with PreCI had a significantly increased incidence of POCD at 7 days and 3 months and cognitive decline at 12 months.
CONCLUSIONS
Patients with PreCI have an increased incidence of POCD and cognitive decline. PreCI is a good predictor of subsequent POCD and cognitive decline. The incidence of cognitive decline after 12 months in this group of patients is low.
背景
本研究调查了老年非心脏手术患者认知障碍的患病率，以及术前认知障碍与术后认知功能障碍（POCD）之间的任何关联。此外，还确定了术后12个月时认知衰退的发生率。
方法
在一项前瞻性观察性临床试验中，对300例接受髋关节置换术的患者和51例60岁及以上的非手术对照者进行了研究。所有研究参与者和对照者在手术前以及术后7天、3个月和12个月完成了一系列八项神经心理学测试。术前认知状态采用预先存在的认知障碍（PreCI）进行评估，PreCI定义为与人群规范相比，在七项神经心理学测试中的两项或更多项上至少下降2个标准差。使用基于对照组结果的可靠变化指数评估POCD和认知衰退。
结果
300例患者中有96例（32%）（95%CI，23%至43%）被分类为PreCI。术后，分别有286例患者中的49例（17%）（95%CI，13%至22%）和284例患者中的27例（10%）（95%CI，6%至13%）在术后7天和3个月出现POCD，而271例患者中有7例（3%）（95%CI，1%至4%）在术后12个月出现认知衰退。PreCI患者在术后7天和3个月出现POCD以及在术后12个月出现认知衰退的发生率显著增加。
结论
PreCI患者发生POCD和认知衰退的发生率增加。PreCI是后续POCD和认知衰退的良好预测指标。该组患者术后12个月时认知衰退的发生率较低。
Zotero 插件