Paredes S, Cortínez L, Contreras V, Silbert B
Anesthesiology Division, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Fitzroy, Vic., Australia.
Acta Anaesthesiol Scand. 2016 Sep;60(8):1043-58. doi: 10.1111/aas.12724. Epub 2016 Mar 29.
Post-operative cognitive dysfunction is defined as a decline in cognitive functions that occurs after surgery, but different diagnostic criteria and incidences have been reported in medical literature. Our aim was to determine incidence of post-operative cognitive dysfunction 3 months after non-cardiac surgery in adults.
A systematic review of available evidence was performed by PRISMA guidelines. A search was done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical Trials, and Grey Literature Reports. Inclusion criteria were prospective design studies with patients over 18 years old, surgery under general or regional anesthesia, follow-up for 3 months, and use of a neurocognitive battery for diagnosis. We excluded studies made on cardiac or brain surgery patients. Risk of bias was assessed using tools from National Heart Lung and Blood Institute.
We selected 24 studies. Average age was 68 years. Only five studies reported incidence of cognitive decline for a non-surgical control group. Median number of tests used was 5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological differences between studies. Increasing age was the most consistent risk factor identified (seven studies).
Post-operative cognitive dysfunction in patients is frequent, especially in patients over 60 years old. Limitations include methodological differences in studies. Efforts must be made to reach a consensus in definition and diagnosis for future research.
术后认知功能障碍被定义为手术后出现的认知功能下降，但医学文献中报道的诊断标准和发病率各不相同。我们的目的是确定成人非心脏手术后3个月时术后认知功能障碍的发病率。
按照PRISMA指南对现有证据进行系统评价。于2015年5月至7月在PubMed、EMBASE、CINAHL、LILACS、Scielo、临床试验和灰色文献报告中进行检索。纳入标准为前瞻性设计研究，患者年龄超过18岁，接受全身或区域麻醉下的手术，随访3个月，并使用神经认知测试组合进行诊断。我们排除了针对心脏或脑部手术患者的研究。使用美国国立心肺血液研究所的工具评估偏倚风险。
我们筛选出24项研究。平均年龄为68岁。只有5项研究报告了非手术对照组的认知功能下降发病率。使用的测试中位数为5项（范围3 - 13项）。术后3个月时术后认知功能障碍的合并发病率为11.7%[95%可信区间10.9 - 12.5]，但各研究之间存在若干方法学差异。年龄增长是确定的最一致的危险因素（7项研究）。
患者术后认知功能障碍很常见，尤其是60岁以上的患者。局限性包括研究中的方法学差异。必须努力在定义和诊断方面达成共识，以便未来开展研究。
