Long-term cognitive impairment after critical illness.
Long-term cognitive impairment after critical illness.
复制标题
DOI：
10.1056/nejmoa1301372
复制
发表时间：
2013-10-03
期刊：
影响因子：
--
通讯作者：
BRAIN-ICU Study Investigators
中科院分区：
文献类型：
--
作者：
Pandharipande PP;Girard TD;Jackson JC;Morandi A;Thompson JL;Pun BT;Brummel NE;Hughes CG;Vasilevskis EE;Shintani AK;Moons KG;Geevarghese SK;Canonico A;Hopkins RO;Bernard GR;Dittus RS;Ely EW;BRAIN-ICU Study Investigators
危重疾病的幸存者通常有一种长期的、致残的认知障碍形式，仍然没有得到充分的特征。我们在内科或外科重症监护病房(ICU)招募有呼吸衰竭或休克的成年人，评估他们的院内精神错乱，并在出院后3个月和12个月使用可重复神经心理状态评估成套测验(人口年龄调整后的平均[±SD]得分，100±15，较低的值表明整体认知能力较差)和B部分的连线测验(人口年龄、性别和教育调整后的平均得分，50±10，得分较低，表明执行功能较差)来评估全球认知和执行功能。使用线性回归，并对潜在的混杂因素进行调整，评估了精神错乱的持续时间和镇静或止痛剂的使用与结果的相关性。在入选的821名患者中，6%的患者在基线时有认知障碍，74%的患者在住院期间出现了精神错乱。在3个月时，40%的患者的总体认知得分低于总体平均数1.5 SD(与中度创伤性脑损伤患者的得分相似)，26%的患者的得分低于总体平均数2 SD(与轻度阿尔茨海默病患者的得分相似)。在年龄较大和年龄较小的患者中都存在缺陷，并持续存在，在所有在12个月时进行评估的患者中，34%和24%的患者在12个月时的评分分别与中度创伤性脑损伤患者和轻度阿尔茨海默病患者的评分相似。精神障碍持续时间越长，3个月和12个月的总体认知功能越差(P=0.001和P=0.04)，3个月和12个月的执行功能越差(P=0.004和P=0.007)。在3个月和12个月时，使用镇静剂或止痛药并不总是与认知障碍有关。内科和外科ICU中的患者长期认知障碍的风险很高。在医院里精神错乱的持续时间越长，在3个月和12个月时的总体认知和执行功能评分就越差。(由美国国立卫生研究院和其他机构资助；Brain-ICU ClinicalTrials.gov编号，NCT00392795。)
Survivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized. We enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge with the use of the Repeatable Battery for the Assessment of Neuropsychological Status (population age-adjusted mean [±SD] score, 100±15, with lower values indicating worse global cognition) and the Trail Making Test, Part B (population age-, sex-, and education-adjusted mean score, 50±10, with lower scores indicating worse executive function). Associations of the duration of delirium and the use of sedative or analgesic agents with the outcomes were assessed with the use of linear regression, with adjustment for potential confounders. Of the 821 patients enrolled, 6% had cognitive impairment at baseline, and delirium developed in 74% during the hospital stay. At 3 months, 40% of the patients had global cognition scores that were 1.5 SD below the population means (similar to scores for patients with moderate traumatic brain injury), and 26% had scores 2 SD below the population means (similar to scores for patients with mild Alzheimer's disease). Deficits occurred in both older and younger patients and persisted, with 34% and 24% of all patients with assessments at 12 months that were similar to scores for patients with moderate traumatic brain injury and scores for patients with mild Alzheimer's disease, respectively. A longer duration of delirium was independently associated with worse global cognition at 3 and 12 months (P = 0.001 and P = 0.04, respectively) and worse executive function at 3 and 12 months (P = 0.004 and P = 0.007, respectively). Use of sedative or analgesic medications was not consistently associated with cognitive impairment at 3 and 12 months. Patients in medical and surgical ICUs are at high risk for long-term cognitive impairment. A longer duration of delirium in the hospital was associated with worse global cognition and executive function scores at 3 and 12 months. (Funded by the National Institutes of Health and others; BRAIN-ICU ClinicalTrials.gov number, NCT00392795.)