Association between delirium and cognitive change after cardiac surgery
Association between delirium and cognitive change after cardiac surgery
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DOI：
10.1093/bja/aex053
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发表时间：
2017-08-01
影响因子：
9.8
通讯作者：
van Dijk, D.
中科院分区：
文献类型：
--
作者：
Sauer, A. C.;Veldhuijzen, D. S.;van Dijk, D.
背景关于术后谵妄（POD）是否是术后认知功能下降（POCD）的危险因素，既往研究提供的数据不一致。因此，我们研究了POD和心脏手术后认知变化之间的关系，并评估了术前认知领域评分和POD之间的关系。采用适用于重症监护室的意识模糊评估方法（CAM）和常规CAM并结合病历审查评估术后谵妄。在择期心脏手术前、手术后1个月和1年，采用神经心理学成套测验评估患者的认知功能。使用可靠变化指数（RCI）计算认知变化。多元线性回归用于校正混杂因素。在完成基线评估的184例患者中，23例（12.5%）发生POD。在1个月时，POD患者的认知能力下降[中位复合RCI-1.00，四分位距（IQR）-1.67至0.28]比无POD患者更严重（RCI-0.04，IQR -0.70至0.63，P=0.02）。在1年时，与基线相比，两组均显示出认知改善（POD患者的中位复合RCI为0.25，IQR为-0.42至1.31，而非POD患者的RCI为0.92，IQR为0.18-1.53; P=0.08）。对年龄和教育水平差异的校正并没有改变结果。术后POD患者在术前Trailmaking测试A部分的表现低于无POD患者（P=0.03）。术后谵妄与术后1个月认知功能下降独立相关，但认知功能通常在1年内恢复。有POD倾向的患者可以在手术前通过注意力任务中的较差表现来识别。
Background. Previous studies provide inconsistent data on whether postoperative delirium (POD) is a risk factor for postoperative cognitive decline (POCD). We thus investigated the relationship between POD and cognitive change after cardiac surgery and assessed the relationship between preoperative cognitive domain scores and POD.Methods. Postoperative delirium was assessed with the Confusion Assessment Method (CAM) adapted for the intensive care unit and the conventional CAM accompanied by chart review. Cognitive function was assessed with a neuropsychological test battery before elective cardiac surgery and 1 month and 1 yr afterwards. Cognitive change was calculated using the Reliable Change Index (RCI). Multiple linear regression was used to adjust for confounding.Results. Of the 184 patients who completed baseline assessment, 23 (12.5%) developed POD. At 1 month, the decline in cognitive performance was worse in patients with POD [median composite RCI -1.00, interquartile range (IQR) -1.67 to 0.28] than in patients without POD (RCI -0.04, IQR -0.70 to 0.63, P=0.02). At 1 yr, both groups showed cognitive improvement on average compared with baseline (POD patients median composite RCI 0.25, IQR -0.42 to 1.31, vs non-POD patients RCI 0.92, IQR 0.18-1.53; P=0.08). Correction for differences in age and level of education did not change the results. Patients with POD performed less well than patients without POD on the preoperative Trailmaking test part A (P=0.03).Conclusions. Postoperative delirium is independently associated with cognitive decline 1 month after surgery, but cognitive performance generally recovers in 1 yr. Patients with a predisposition to POD can be identified before surgery by worse performance in an attention task.