School of Anesthesiology, Weifang Medical University, Weifang 261053, China.
Department of Anesthesiology, Weifang People's Hospital, Weifang 261041, China.
Biomed Res Int. 2022 Feb 18;2022:5372603. doi: 10.1155/2022/5372603. eCollection 2022.
Cognitive dysfunction after total knee arthroplasty (TKA) is very common in elderly patients. Postoperative cognitive dysfunction (POCD), as a form of cognitive dysfunction, may affect patients' short- and long-term recoveries. The identification of meaningful risk factors may help reduce the occurrence of POCD in the future.
Our goal was to retrospectively investigate the risk factors for early POCD in elderly patients undergoing TKA and to further analyze the relationship between the intensity of risk factors and the level of cognitive function.
The related indicators and the Montreal Cognitive Function Assessment Scale (MOCA) scores of 105 elderly patients were collected by searching the electronic case system. According to the postoperative MOCA score, patients were divided into three groups: normal group (group N), mild POCD group (group M), and severe POCD group (group S). SPSS 25.0 software was used for statistical analyses.
At baseline, the preoperative MOCA score was significantly different in patients with POCD ( ≤ 0.001), while other baseline indicators were not significantly different. In terms of changes in hemoglobin levels, statistically significant differences were observed between group M, group S, and group N ( = 0.039). Among inflammatory indicators, only postoperative CRP levels showed a statistically significant difference in patients with POCD ( = 0.041). Postoperative pain was also significantly different among the three groups ( = 0.009). The multivariate regression analysis revealed that a low preoperative MOCA score and severe postoperative pain were independent risk factors for mild and severe cognitive impairment, while a high postoperative CRP level was only an independent risk factor for mild cognitive impairment.
Our study found that the level of preoperative cognitive function, postoperative CRP level, and postoperative pain were independent risk factors for POCD. Moreover, the levels of preoperative cognitive function and postoperative pain were more strongly correlated with severe POCD than postoperative CRP levels.
全膝关节置换术后认知功能障碍在老年患者中非常常见。术后认知功能障碍（POCD）作为认知功能障碍的一种形式，可能会影响患者的短期和长期恢复。识别有意义的危险因素有助于减少未来 POCD 的发生。
本研究旨在回顾性分析老年患者全膝关节置换术后早期 POCD 的危险因素，并进一步分析危险因素强度与认知功能水平的关系。
通过检索电子病案系统，收集了 105 例老年患者的相关指标和蒙特利尔认知功能评估量表（MOCA）评分。根据术后 MOCA 评分，患者分为正常组（组 N）、轻度 POCD 组（组 M）和重度 POCD 组（组 S）。采用 SPSS 25.0 软件进行统计分析。
在基线时，POCD 患者的术前 MOCA 评分明显不同（P < 0.001），而其他基线指标无明显差异。在血红蛋白水平变化方面，组 M、组 S 和组 N 之间存在统计学差异（P = 0.039）。在炎症指标方面，只有 POCD 患者的术后 CRP 水平存在统计学差异（P = 0.041）。三组患者术后疼痛也存在显著差异（P = 0.009）。多变量回归分析显示，术前 MOCA 评分低和术后疼痛严重是轻度和重度认知障碍的独立危险因素，而术后 CRP 水平升高仅为轻度认知障碍的独立危险因素。
本研究发现术前认知功能水平、术后 CRP 水平和术后疼痛是 POCD 的独立危险因素。此外，术前认知功能水平和术后疼痛与重度 POCD 的相关性强于术后 CRP 水平。
