Igarashi T, Konishi A, Sonehara D, Asahara H
Department of Anesthesiology, Mitsui Memorial Hospital, Tokyo.
Masui. 1995 Jan;44(1):60-5.
In 190 patients, we studied changes in intellectual status during perioperative period using Hasegawa's Dementia Scale (HDS-R), and analyzed preoperative, intraoperative, and postoperative risk factors. HDS-R is one of the most popular scoring tests for evaluating dementia or delirium. Risk factors impairing preoperative score were aging, and preoperative complications including cerebral vascular disease, old myocardial infarction, arrythmia, and diabetes mellitus. Risk factors impairing postoperative score were, in addition to above-mentioned factors, hypoproteinemia and postoperative stressful conditions such as prolonged fever, pain, bed rest, and naso-gastric tube. In the patients who showed postoperative score deterioration, the incidence of old myocardial infarction, hypertension, and postoperative stressful conditions was significantly greater. In the patients who showed postoperative score improvement, local anesthesia including epidural and spinal anesthesia was used more often. In conclusion, aging or preoperative complications such as cerebral vascular disease, old myocardial infarction, arrythmia, and diabetes mellitus are high risks for the development of postoperative dementia and delirium under general surgical procedures and general anesthesia. Intraoperative management with patients awake using local anesthesia and postoperative stress-less conditions are important to avoid postoperative dementia.
我们对190例患者使用长谷川痴呆量表（HDS-R）研究围手术期智力状态的变化，并分析术前、术中和术后的危险因素。HDS-R是评估痴呆或谵妄最常用的评分测试之一。影响术前评分的危险因素为年龄增长以及术前并发症，包括脑血管疾病、陈旧性心肌梗死、心律失常和糖尿病。除上述因素外，影响术后评分的危险因素还有低蛋白血症以及术后应激状况，如长期发热、疼痛、卧床休息和鼻胃管置入。术后评分恶化的患者中，陈旧性心肌梗死、高血压和术后应激状况的发生率显著更高。术后评分改善的患者中，硬膜外麻醉和脊髓麻醉等局部麻醉的使用更为频繁。总之，年龄增长或术前并发症，如脑血管疾病、陈旧性心肌梗死、心律失常和糖尿病，是普通外科手术和全身麻醉下术后发生痴呆和谵妄的高风险因素。采用局部麻醉使患者术中保持清醒的管理方式以及术后无应激状况对于避免术后痴呆很重要。
