心脏手术后谵妄与认知变化的关系。

Association between delirium and cognitive change after cardiac surgery.

机构信息

Department of Anesthesiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.

Institute of Psychology, Health, Medical, and Neuropsychology Unit, Faculty of Social Sciences, Leiden University, PO Box 9555, RB 2300 Leiden, The Netherlands.

出版信息

Br J Anaesth. 2017 Aug 1;119(2):308-315. doi: 10.1093/bja/aex053.

DOI:10.1093/bja/aex053

PMID:28854542

Abstract

BACKGROUND

Previous studies provide inconsistent data on whether postoperative delirium (POD) is a risk factor for postoperative cognitive decline (POCD). We thus investigated the relationship between POD and cognitive change after cardiac surgery and assessed the relationship between preoperative cognitive domain scores and POD.

METHODS

Postoperative delirium was assessed with the Confusion Assessment Method (CAM) adapted for the intensive care unit and the conventional CAM accompanied by chart review. Cognitive function was assessed with a neuropsychological test battery before elective cardiac surgery and 1 month and 1 yr afterwards. Cognitive change was calculated using the Reliable Change Index (RCI). Multiple linear regression was used to adjust for confounding.

RESULTS

Of the 184 patients who completed baseline assessment, 23 (12.5%) developed POD. At 1 month, the decline in cognitive performance was worse in patients with POD [median composite RCI -1.00, interquartile range (IQR) -1.67 to 0.28] than in patients without POD (RCI -0.04, IQR -0.70 to 0.63, P =0.02). At 1 yr, both groups showed cognitive improvement on average compared with baseline (POD patients median composite RCI 0.25, IQR -0.42 to 1.31, vs non-POD patients RCI 0.92, IQR 0.18-1.53; P =0.08). Correction for differences in age and level of education did not change the results. Patients with POD performed less well than patients without POD on the preoperative Trailmaking test part A ( P =0.03).

CONCLUSIONS

Postoperative delirium is independently associated with cognitive decline 1 month after surgery, but cognitive performance generally recovers in 1 yr. Patients with a predisposition to POD can be identified before surgery by worse performance in an attention task.

CLINICAL TRIAL REGISTRATION

NCT00293592.

摘要

背景

先前的研究对术后谵妄（POD）是否是术后认知障碍（POCD）的危险因素提供了不一致的数据。因此，我们调查了心脏手术后 POD 与认知变化之间的关系，并评估了术前认知域评分与 POD 之间的关系。

方法

使用改良后的 ICU 意识模糊评估法（CAM）和常规 CAM 并结合图表回顾评估术后谵妄。在择期心脏手术前、1 个月和 1 年后使用神经心理学测试组合评估认知功能。使用可靠变化指数（RCI）计算认知变化。使用多元线性回归调整混杂因素。

结果

在完成基线评估的 184 名患者中，23 名（12.5%）发生 POD。在 1 个月时，POD 患者的认知表现下降更严重[中位数复合 RCI -1.00，四分位距（IQR）-1.67 至 0.28]，而无 POD 患者的认知表现下降更严重（RCI -0.04，IQR -0.70 至 0.63，P =0.02）。在 1 年时，与基线相比，两组患者的认知功能均平均改善（POD 患者中位数复合 RCI 0.25，IQR -0.42 至 1.31，非 POD 患者 RCI 0.92，IQR 0.18-1.53；P =0.08）。校正年龄和教育程度的差异并未改变结果。POD 患者在术前 Trailmaking 测试 A 部分的表现逊于非 POD 患者（P =0.03）。