老年患者术后谵妄与后期的认知损害有关
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Postoperative delirium in elderly patients is associated with subsequent cognitive impairment
背景与目的：我们研究了轻度认知损害（MCI）或痴呆患者发生术后谵妄（POD）的风险，以及认知正常老年患者中MCI或痴呆的进展和术后谵妄之间的关系。
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方法：纳入2004至2014年，年龄为65岁病人，麻醉方式不限。通过神经心理学测试和临床评估评估术前和术后的认知状态，定义为正常或MCI /痴呆。用ICU混淆评定法检测术后谵妄。进行logistic回归分析。
结果：2014例外科手术患者中，有74例（3.7%）出现了POD。手术前，1667名患者认知正常，347人符合MCI/痴呆标准。与术前认知正常的患者相比，存在MCI/痴呆的患者术后发生POD的比例更高{分别为8.7%和2.6%，比值比（OR）2.53，[ 95%CI,1.52 - 4.21 ]；P＜0.001}。术后谵妄与低教育水平有关[P¼0.002是小于12年教育与大于等于16年教育的比，（OR，3.40；95% CI，1.60–7.40）]。1667名认知水平正常的患者在他们的随后的评估中，1152名患者术后的认知水平正常，另外109名患者（9.5%）符合MCI /痴呆标准。在术后首次进行MCI /痴呆评估时，发生POD的患者与那些没有发生的相比，更容易发生后期的认知损害，[ 33.3% vs 9%；调整后OR 3.0（95% CI，1.12–8.05）；P¼0.029 ]。
结论：术前轻度认知损害或痴呆是POD的危险因素。术前未被诊断存在MCI/痴呆，但发生POD的老年患者更易发生后期的MCI/痴呆。
Sprung, J., et al., Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. Br J Anaesth, 2017. 119(2): 316-323.
Background:We examined the risk for postoperative delirium (POD) in patients with mild cognitive impairment (MCI) or dementia, and the association between POD and subsequent development of MCI or dementia in cognitively normal elderly patients.
Methods:Patients 65 yr of age enrolled in the Mayo Clinic Study of Aging who were exposed to any type of anaesthesia from 2004 to 2014 were included. Cognitive status was evaluated before and after surgery by neuropsychological testing and clinical assessment, and was defined as normal or MCI/dementia. Postoperative delirium was detected with the Confusion Assessment Method for the intensive care unit. Logistic regression analyses were performed.
Results:Among 2014 surgical patients, 74 (3.7%) developed POD. Before surgery, 1667 participants were cognitively normal,and 347 met MCI/dementia criteria. The frequency of POD was higher in patients with pre-existing MCI/dementia compared with no MCI/dementia {8.7 vs 2.6%; odds ratio (OR) 2.53, [95% confidence interval (CI) 1.52–4.21]; P<0.001}. Postoperative delirium was associated with lower education [OR, 3.40 (95% CI, 1.60–7.40); P¼0.002 for those with <12 vs >16 yr of schooling].Of the 1667 patients cognitively normal at their most recent assessment, 1152 returned for postoperative evaluation, and109 (9.5%) met MCI/dementia criteria. The frequency of MCI/dementia at the first postoperative evaluation was higher in patients who experienced POD compared with those who did not [33.3 vs 9.0%; adjusted OR, 3.00 (95% CI, 1.12–8.05);P¼0.029].
Conclusion: Mild cognitive impairment or dementia is a risk for POD. Elderly patients who have not been diagnosed with MCI or dementia but experience POD are more likely to be diagnosed subsequently with MCI or dementia.
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