衰弱与老年非心脏手术患者术后谵妄相关，但与术后认知下降无关。
Frailty Is Associated With Postoperative Delirium But Not With Postoperative Cognitive Decline in Older Noncardiac Surgery Patients.
机构信息
From the Department of Anesthesiology, Perioperative and Pain Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Rutgers New Jersey Medical School, Newark, New Jersey.
出版信息
Anesth Analg. 2020 Jun;130(6):1516-1523. doi: 10.1213/ANE.0000000000004773.
BACKGROUND
Postoperative cognitive dysfunction (POCD) and delirium are the most common perioperative cognitive complications in older adults undergoing surgery. A recent study of cardiac surgery patients suggests that physical frailty is a risk factor for both complications. We sought to examine the relationship between preoperative frailty and postoperative delirium and preoperative frailty and POCD after major noncardiac surgery.
METHODS
We performed a prospective cohort study of patients >65 years old having major elective noncardiac surgery with general anesthesia. Exclusion criteria were preexisting dementia, inability to consent, cardiac, intracranial, or emergency surgery. Preoperative frailty was determined using the FRAIL scale, a simple questionnaire that categorizes patients as robust, prefrail, or frail. Delirium was assessed with the Confusion Assessment Method for the intensive care unit (CAM-ICU) twice daily, starting in the recovery room until hospital discharge. All patients were assessed with neuropsychological tests (California Verbal Learning Test II, Trail Making Test, subtests from the Wechsler Adult Intelligence Scale, Logical Memory Story A, Immediate and Delayed Recall, Animal and Vegetable verbal fluency, Boston Naming Test, and the Mini-Mental Status Examination) before surgery and at 3 months afterward.
RESULTS
A total of 178 patients met inclusion criteria; 167 underwent major surgery and 150 were available for follow-up 3 months after surgery. The median age was 70 years old. Thirty-one patients (18.6%) tested as frail, and 72 (43.1%) prefrail before surgery. After adjustment for baseline cognitive score, age, education, surgery duration, American Society of Anesthesiologists (ASA) physical status, type of surgery, and sex, patients who tested frail or prefrail had an estimated 2.7 times the odds of delirium (97.5% confidence interval, 1.0-7.3) when compared to patients who were robust. There was no significant difference between the proportion of POCD between patients who tested as frail, prefrail, or robust.
CONCLUSIONS
After adjustment for baseline cognition, testing as frail or prefrail with the FRAIL scale is associated with increased odds of postoperative delirium, but not POCD after noncardiac surgery.
背景
术后认知功能障碍（POCD）和谵妄是老年患者接受手术时最常见的围手术期认知并发症。最近一项心脏手术患者的研究表明，身体虚弱是这两种并发症的一个危险因素。我们试图研究术前虚弱与术后谵妄以及非心脏大手术后术前虚弱与 POCD 之间的关系。
方法
我们对接受全身麻醉的 65 岁以上择期非心脏大手术的患者进行了一项前瞻性队列研究。排除标准为：痴呆、无能力同意、心脏、颅内或急诊手术。使用 FRAIL 量表来确定术前虚弱，这是一种简单的问卷，可将患者分为健壮、虚弱前期或虚弱。使用 ICU 意识模糊评估法（CAM-ICU）每天两次评估谵妄，从恢复室开始，直到出院。所有患者在手术前和术后 3 个月均接受神经心理测试（加利福尼亚语言学习测试 II、连线测试、韦氏成人智力量表的子测验、逻辑记忆故事 A、即刻和延迟回忆、动物和植物言语流畅性、波士顿命名测试和简易精神状态检查）。
结果
共有 178 名患者符合纳入标准；167 名患者接受了大手术，150 名患者可在术后 3 个月进行随访。中位年龄为 70 岁。31 名患者（18.6%）测试为虚弱，72 名患者（43.1%）手术前为虚弱前期。调整基线认知评分、年龄、教育、手术时间、美国麻醉医师协会（ASA）身体状况、手术类型和性别后，与健壮患者相比，测试为虚弱或虚弱前期的患者发生谵妄的几率估计增加 2.7 倍（97.5%置信区间，1.0-7.3）。在测试为虚弱、虚弱前期或健壮的患者中，POCD 的比例没有显著差异。
结论
在调整基线认知后，使用 FRAIL 量表测试为虚弱或虚弱前期与术后谵妄的几率增加相关，但与非心脏手术后的 POCD 无关。
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