Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial.
Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial.
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DOI：
10.1371/journal.pone.0037410
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Green D
中科院分区：
文献类型：
--
作者：
Ballard C;Jones E;Gauge N;Aarsland D;Nilsen OB;Saxby BK;Lowery D;Corbett A;Wesnes K;Katsaiti E;Arden J;Amoako D;Prophet N;Purushothaman B;Green D
该研究确定了一年内手术后认知能力下降（POCD）的发生率，并评估了术中麻醉干预在减少择期骨科或腹部手术老年人（60岁以上）术后认知功能障碍方面的有效性。该设计是一项前瞻性队列研究，采用嵌套随机对照干预试验，使用术中双谱指数和脑氧饱和度监测来优化接受手术的老年人的麻醉深度和脑氧饱和度。在52周的前瞻性队列研究中（192例手术患者和138例对照组），52周后，手术患者轻度（χ2 = 17.9 p<0.0001）、中度（χ2 = 7.8 p = 0.005）和重度（χ2 = 5.1 p = 0.02） POCD均显著高于年龄匹配对照组。在巢式随机对照试验中，81例患者被随机分组，73例参与数据分析（干预34例，对照组39例）。干预组轻度POCD在1、12、52周显著降低（χ2 = 5.1 p = 0.02, χ2 = 5.9 p = 0.015），中度POCD在1、52周显著降低（χ2 = 4.4 p = 0.037, χ2 = 5.4 p = 0.02）。除了有显著提高反应时间跨度为(警戒反应时间MWU Z =−2.1 p = 0.03, MWU Z =−2.7 p = 0.004, MWU Z =−3.0 p = 0.005),在患者和52周(MWU Z =−2.9 p = 0.003, MWU Z =−3.3 p = 0.001),执行功能在12和52周(小道让MWU Z =−2.4 p = .0.018 MWU Z =−2.4 p = 0.019)。POCD在手术后的老年人中很常见且持续存在。巢式随机对照试验的结果表明，术中监测麻醉深度和脑氧合作为一种实用的干预措施，可以减少术后认知功能障碍，具有潜在的益处。Controlled-Trials.com ISRCTN39503939
The study determined the one year incidence of post operative cognitive decline (POCD) and evaluated the effectiveness of an intra-operative anaesthetic intervention in reducing post-operative cognitive impairment in older adults (over 60 years of age) undergoing elective orthopaedic or abdominal surgery. The design was a prospective cohort study with a nested randomised, controlled intervention trial, using intra-operative BiSpectral index and cerebral oxygen saturation monitoring to enable optimisation of anaesthesia depth and cerebral oxygen saturation in older adults undergoing surgery. In the 52 week prospective cohort study (192 surgical patients and 138 controls), mild (χ2 = 17.9 p<0.0001), moderate (χ2 = 7.8 p = 0.005) and severe (χ2 = 5.1 p = 0.02) POCD were all significantly higher after 52 weeks in the surgical patients than among the age matched controls. In the nested RCT, 81 patients were randomized, 73 contributing to the data analysis (34 intervention, 39 control). In the intervention group mild POCD was significantly reduced at 1, 12 and 52 weeks (Fisher’s Exact Test p = 0.018, χ2 = 5.1 p = 0.02 and χ2 = 5.9 p = 0.015), and moderate POCD was reduced at 1 and 52 weeks (χ2 = 4.4 p = 0·037 and χ2 = 5.4 p = 0.02). In addition there was significant improvement in reaction time at all time-points (Vigilance Reaction Time MWU Z = −2.1 p = 0.03, MWU Z = −2.7 p = 0.004, MWU Z = −3.0 p = 0.005), in MMSE at one and 52 weeks (MWU Z = −2.9 p = 0.003, MWU Z = −3.3 p = 0.001), and in executive function at 12 and 52 weeks (Trail Making MWU Z = −2.4 p = .0.018, MWU Z = −2.4 p = 0.019). POCD is common and persistent in older adults following surgery. The results of the nested RCT indicate the potential benefits of intra-operative monitoring of anaesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive impairment. Controlled-Trials.com ISRCTN39503939
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