Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Surgery/ Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
BMC Anesthesiol. 2023 Nov 10;23(1):368. doi: 10.1186/s12871-023-02318-3.
Postoperative neurocognitive disorder (pNCD) is common after surgery. Exposure to anaesthetic drugs has been implicated as a potential cause of pNCD. Although several studies have investigated risk factors for the development of cognitive impairment in the early postoperative phase, risk factors for pNCD at 3 months have been less well studied. The aim of this study was to identify potential anaesthesia-related risk factors for pNCD at 3 months after surgery.
We analysed data obtained for a prospective observational study in patients aged ≥ 65 years who underwent surgery for excision of a solid tumour. Cognitive function was assessed preoperatively and at 3 months postoperatively using 5 neuropsychological tests. Postoperative NCD was defined as a postoperative decline of ≥ 25% relative to baseline in ≥ 2 tests. The association between anaesthesia-related factors (type of anaesthesia, duration of anaesthesia, agents used for induction and maintenance of anaesthesia and analgesia, the use of additional vasoactive medication, depth of anaesthesia [bispectral index] and mean arterial pressure) and pNCD was analysed using logistic regression analyses. Furthermore, the relation between anaesthesia-related factors and change in cognitive test scores expressed as a continuous variable was analysed using a z-score.
Of the 196 included patients, 23 (12%) fulfilled the criteria for pNCD at 3 months postoperatively. A low preoperative score on Mini-Mental State Examination (OR, 8.9 [95% CI, (2.8-27.9)], p < 0.001) and a longer duration of anaesthesia (OR, 1.003 [95% CI, (1.001-1.005)], p = 0.013) were identified as risk factors for pNCD. On average, patients scored higher on postoperative tests (mean z-score 2.35[± 3.13]).
In this cohort, duration of anaesthesia, which is probably an expression of the complexity of the surgery, was the only anaesthesia-related predictor of pNCD. On average, patients' scores on cognitive tests improved postoperatively.
术后认知障碍（pNCD）在手术后很常见。接触麻醉药物已被认为是导致 pNCD 的潜在原因之一。尽管有几项研究调查了术后早期认知障碍发展的危险因素，但 pNCD 在 3 个月时的危险因素研究较少。本研究旨在确定与术后 3 个月 pNCD 相关的潜在麻醉相关危险因素。
我们分析了一项针对年龄≥65 岁接受实体瘤切除术的患者的前瞻性观察研究的数据。使用 5 项神经心理学测试在术前和术后 3 个月评估认知功能。术后认知障碍定义为术后与基线相比，≥2 项测试下降≥25%。使用逻辑回归分析评估与麻醉相关因素（麻醉类型、麻醉持续时间、麻醉和镇痛诱导和维持药物、血管活性药物的使用、麻醉深度[双频谱指数]和平均动脉压）和 pNCD 之间的关联。此外，还使用 z 分数分析了麻醉相关因素与作为连续变量的认知测试评分变化之间的关系。
在纳入的 196 名患者中，23 名（12%）在术后 3 个月时符合 pNCD 标准。术前简易精神状态检查（MMSE）评分较低（OR，8.9[95%CI，（2.8-27.9）]，p<0.001）和麻醉时间较长（OR，1.003[95%CI，（1.001-1.005）]，p=0.013）被确定为 pNCD 的危险因素。平均而言，患者在术后测试中的得分较高（平均 z 分数 2.35[±3.13]）。
在本队列中，麻醉持续时间（可能是手术复杂性的表现）是唯一与麻醉相关的 pNCD 预测因素。平均而言，患者的认知测试评分在术后有所提高。
