体力活动与术后谵妄风险。
Physical Activity and Risk of Postoperative Delirium.
机构信息
Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
出版信息
J Am Geriatr Soc. 2019 Nov;67(11):2260-2266. doi: 10.1111/jgs.16083. Epub 2019 Aug 1.
BACKGROUND/OBJECTIVE: Regular physical activity (PA) has been associated with improved cognitive function, but its effect on postoperative delirium (POD) has not been established. Our objectives were to determine the effect of baseline PA on the incidence of POD in older patients undergoing elective orthopedic surgery and to determine whether these effects were independent of cognitive reserve. We hypothesize that PA protects against POD by bolstering physiologic reserve needed to withstand the stressors of surgery.
DESIGN
Secondary analysis of a prospective, single-center, cohort study.
SETTING
Urban academic hospital.
PARTICIPANTS
A total of 132 nondemented, English-speaking adults older than 60 years undergoing elective orthopedic surgery.
MEASUREMENTS
Subjects were screened for POD and delirium severity using the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Baseline cognitive activities and PAs were assessed with a validated Leisure Activity Scale. Regular PA was categorized as 6 to 7 days per week. The association of regular PA with incidence of POD was assessed using multivariable logistic regression, adjusting for age, sex, Charlson Comorbidity Index, cognitive reserve, and cognitive function. Linear regression was used to assess the association of delirium severity with regular PA.
RESULTS
Of 132 patients, 41 (31.1%) developed POD. Regular PA was associated with a 74% lower odds of developing POD (odds ratio [OR] = 0.26; 95% confidence interval [CI] = 0.08-0.82). There was no significant interaction between PA and cognitive reserve (P = .70). Of 85 women, 25 (29.4%), and of 47 men, 16 (34.0%) developed POD. In stratified analysis, women who engaged in regular PA had dramatically lower odds of POD (OR = 0.08; 95% CI = 0.01-0.63) compared with men (OR = 0.93; 95% CI = 0.18-4.97).
CONCLUSIONS
Regular PA is associated with decreased incidence of POD, especially among women. Future studies should address the basis of sex differences in PA benefits on delirium. J Am Geriatr Soc 67:2260-2266, 2019.
背景/目的：有规律的身体活动（PA）与认知功能改善有关，但它对术后谵妄（POD）的影响尚未确定。我们的目的是确定基线 PA 对择期骨科手术老年患者 POD 发生率的影响，并确定这些影响是否独立于认知储备。我们假设，PA 通过增强生理储备来保护机体免受手术应激，从而预防 POD。
设计
前瞻性、单中心、队列研究的二次分析。
地点
城市学术医院。
参与者
共纳入 132 名无痴呆、讲英语且年龄大于 60 岁的择期骨科手术患者。
测量方法
采用意识模糊评估法和记忆谵妄评估量表对患者进行 POD 和谵妄严重程度筛查。基线认知活动和 PA 使用经过验证的休闲活动量表进行评估。有规律的 PA 定义为每周 6-7 天。采用多变量逻辑回归评估有规律的 PA 与 POD 发生率的相关性，调整因素包括年龄、性别、Charlson 合并症指数、认知储备和认知功能。采用线性回归评估谵妄严重程度与有规律 PA 的相关性。
结果
在 132 名患者中，41 名（31.1%）发生 POD。有规律的 PA 与发生 POD 的几率降低 74%相关（比值比[OR] = 0.26；95%置信区间[CI] = 0.08-0.82）。PA 与认知储备之间无显著交互作用（P = 0.70）。85 名女性中，25 名（29.4%）发生 POD，47 名男性中，16 名（34.0%）发生 POD。在分层分析中，与男性（比值比[OR] = 0.93；95%置信区间[CI] = 0.18-4.97）相比，有规律 PA 的女性发生 POD 的几率显著降低（OR = 0.08；95% CI = 0.01-0.63）。
结论
有规律的 PA 与 POD 发生率降低相关，特别是在女性中。未来的研究应探讨 PA 对谵妄的性别差异的基础。美国老年学会杂志 67:2260-2266，2019。
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