术后谵妄与日常生活活动能力的长期衰退有关

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Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living

背景与目的

术后谵妄是老年外科患者最常见的并发症之一。然而，其远期结局仍有待确定。因此，我们进行了一项前瞻性队列研究，以确定术后谵妄与日常生活活动能力的长期衰退和术后死亡率之间的关系。本研究假设术后谵妄与麻醉和手术后24-36个月内日常生活活动能力的衰退和死亡率升高有关。

方  法

受试者（≥65岁）接受了股骨近端髓内钉手术、髋关节置换术或全麻下切开复位内固定术。在术前、术后第1天、第2天和第4天用瞻望评定量表（CAM）对谵妄患者进行诊断。采用中文版的日常生活量表（范围14～56分）评定日常生活活动能力，采用中文版的简易智力量表（范围0～30分）评定术前有无认知功能障碍。术后24~36个月进行随访，包括日常生活活动能力和死亡率。

结  果

130名受试者（80±6岁，24%男性）中，34名（26%）在住院期间出现术后谵妄。有32%的受试者失去了随访，最终有88名受试者被纳入数据分析。与无术后谵妄患者相比，术后谵妄患者的日常生活活动能力明显下降（16±15 vs 9±15，P=0.037），36个月死亡率较高（28例中有8例，29 % vs 75例中7例，9%；P=0.009）。

结  论

术后谵妄与长期的有害结局相关，包括日常生活活动能力的极大下降和术后死亡率的增加。

原始文献摘要

Shi Z,  Mei X,  Li C, et al.  Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living [J]. Anesthesiology, 2019, 131: 492-500.

Background: Postoperative delirium is one of the most common complications in the elderly surgical population. However, its long-term outcomes remain largely to be determined. Therefore a prospective cohort study was conducted to determine the association between postoperative delirium and long-term decline in activities of daily living and postoperative mortality. The hypothesis in the present study was that postoperative delirium was associated with a greater decline in activities of daily living and higher mortality within 24 to 36 months after anesthesia and surgery.

Methods: The participants (at least 65 yr old) having the surgeries of (1) proximal femoral nail, (2) hip replacement, or (3) open reduction and internal fixation under general anesthesia were enrolled. The Confusion Assessment Method algorithm was administered to diagnose delirium before and on the first, second, and fourth days after the surgery. Activities of daily living were evaluated by using the Chinese version of the activities of daily living scale (range, 14 to 56 points), and preoperative cognitive function was assessed by using the Chinese Mini-Mental State Examination (range, 0 to 30 points). The follow-up assessments, including activities of daily living and mortality, were conducted between 24 and 36 months after anesthesia and surgery.

Results: Of 130 participants (80 ± 6 yr, 24% male), 34 (26%) developed postoperative delirium during the hospitalization. There were 32% of the participants who were lost to follow-up, resulting in 88 participants who were finally included in the data analysis. The participants with postoperative delirium had a greater decline in activities of daily living (16 ± 15 vs. 9 ± 15, P = 0.037) and higher 36-month mortality (8 of 28, 29% vs. 7 of 75, 9%; P = 0.009) as compared with the participants without postoperative delirium.

Conclusions: Postoperative delirium was associated with long-term detrimental outcomes, including greater decline in activities of daily living and a higher rate of postoperative mortality.

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贵州医科大学高鸿教授课题组

翻译：何幼芹    编辑：何幼芹   审校：王贵龙

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