Cognitive trajectories after postoperative delirium.
Cognitive trajectories after postoperative delirium.
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DOI：
10.1056/nejmoa1112923
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发表时间：
2012-07-05
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影响因子：
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通讯作者：
Jones RN
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作者：
Saczynski JS;Marcantonio ER;Quach L;Fong TG;Gross A;Inouye SK;Jones RN
谵妄在心脏手术后很常见，可能与认知功能的长期变化有关。我们研究了心脏手术后第一年的术后谵妄和认知轨迹。我们招募了225名60岁或以上的患者，他们计划接受冠状动脉旁路移植术或瓣膜置换术。患者在术前、术后第2天开始的住院期间以及术后1个月、6个月和12个月接受评估。使用简易精神状态检查（MMSE;评分范围为0至30，评分越低表示表现越差）评估认知功能。谵妄的诊断与使用的混乱评估方法。我们检查了术后第一年MMSE的表现，控制了人口统计学特征，共存条件，医院和手术类型。术后发生谵妄的103名参与者（46%）的术前平均MMSE评分低于未发生谵妄的参与者（25.8 vs. 26.9，P<0.001）。在调整后的模型中，那些谵妄患者的认知功能下降幅度更大（通过MMSE评分测量）术后2天比那些没有谵妄的人（7.7分vs2.1，P<0.001），术后1个月认知功能明显低于无谵妄者（平均MMSE评分，24.1 vs. 27.4; P<0.001）和术后1年（25.2 vs. 27.2，P<0.001）。校正基线差异后，术后30天平均MMSE评分的组间差异显著（P<0.001），但在6个月或12个月时差异不显著（P = 0.056）。6个月时，发生谵妄的患者未恢复至术前基线水平的百分比高于未发生谵妄的患者（40% vs. 24%，P = 0.01），但12个月时差异不显著（31% vs. 20%，P = 0.055）。谵妄与心脏手术后第一年认知能力的显著下降相关，其轨迹特征为初始下降和长期损害。（由哈佛老年美国人独立中心和其他机构资助。）
Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery. We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day 2, and at 1, 6, and 12 months after surgery. Cognitive function was assessed with the use of the Mini–Mental State Examination (MMSE; score range, 0 to 30, with lower scores indicating poorer performance). Delirium was diagnosed with the use of the Confusion Assessment Method. We examined performance on the MMSE in the first year after surgery, controlling for demographic characteristics, coexisting conditions, hospital, and surgery type. The 103 participants (46%) in whom delirium developed postoperatively had lower pre-operative mean MMSE scores than those in whom delirium did not develop (25.8 vs. 26.9, P<0.001). In adjusted models, those with delirium had a larger drop in cognitive function (as measured by the MMSE score) 2 days after surgery than did those without delirium (7.7 points vs. 2.1, P<0.001) and had significantly lower postoperative cognitive function than those without delirium, both at 1 month (mean MMSE score, 24.1 vs. 27.4; P<0.001) and at 1 year (25.2 vs. 27.2, P<0.001) after surgery. With adjustment for baseline differences, the between-group difference in mean MMSE scores was significant 30 days after surgery (P<0.001) but not at 6 or 12 months (P = 0.056 for both). A higher percentage of patients with delirium than those without delirium had not returned to their preoperative baseline level at 6 months (40% vs. 24%, P = 0.01), but the difference was not significant at 12 months (31% vs. 20%, P = 0.055). Delirium is associated with a significant decline in cognitive ability during the first year after cardiac surgery, with a trajectory characterized by an initial decline and prolonged impairment. (Funded by the Harvard Older Americans Independence Center and others.)