Ability of postoperative delirium to predict intermediate-term postoperative cognitive function in patients undergoing elective surgery at an academic medical centre: protocol for a prospective cohort study.
Ability of postoperative delirium to predict intermediate-term postoperative cognitive function in patients undergoing elective surgery at an academic medical centre: protocol for a prospective cohort study.
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术后谵妄预测在学术医疗中心接受择期手术的患者术后中期认知功能的能力：前瞻性队列研究方案。
DOI：
10.1136/bmjopen-2017-017079
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发表时间：
2018
期刊：
影响因子：
2.9
通讯作者：
Avidan,MichaelSimon
中科院分区：
文献类型：
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作者：
Aranake-Chrisinger,Amrita;Cheng,JennyZhao;Muench,MaxwellR;Tang,Rose;Mickle,Angela;Maybrier,Hannah;Lin,Nan;Wildes,Troy;Lenze,Eric;Avidan,MichaelSimon
术后谵妄（POD）是老年患者的常见并发症，其特征是意识改变、思维紊乱和注意力不集中的波动过程。初步研究表明，POD与持续性认知障碍和生活质量下降有关。然而，这些发现可能与患者合并症、术后并发症和虚弱相混淆。我们的目的是确定POD是否是择期手术后注意力和执行功能持续受损的独立危险因素。我们的中心假设是，与没有POD的患者相比，POD患者在术后1年更有可能出现认知能力和生活质量的下降。我们的目的是澄清这些关联是否独立于潜在的混杂因素。我们还将探讨POD与痴呆之间的关系。方法与分析本研究将从正在进行的麻醉缓解老年综合征脑电图指导（engage）研究中招募200名患者。居住在距离研究中心≤45英里或计划在术后10-16个月访问研究中心的患者将符合条件。用神志不清评定法（Confusion Assessment Method）对POD患者与无谵妄患者进行比较。认知功能的主要结局和生活质量的次要结局以及痴呆的发生率将在队列之间进行比较。认知能力将通过测试A和B和Stroop颜色和单词测试来测量，生活质量采用退伍军人RAND 12项健康调查，痴呆发生率采用短祝福测试。将进行多变量回归分析和Cox比例风险分析。所有结果报告ci为95%，α=0.05。该研究已获得华盛顿大学圣路易斯机构审查委员会（IRB号201601099）的批准。传播计划包括科学出版物和在科学会议上的演讲。试验注册号：bernct02241655。
IntroductionPostoperative delirium (POD) is a common complication in elderly patients, characterised by a fluctuating course of altered consciousness, disordered thinking and inattention. Preliminary research has linked POD with persistent cognitive impairment and decreased quality of life. However, these findings maybe confounded by patient comorbidities, postoperative complications and frailty. Our objective is to determine whether POD is an independent risk factor for persistent impairments in attention and executive function after elective surgery. Our central hypothesis is that patients with POD are more likely to have declines in cognition and quality of life 1 year after surgery compared with patients without POD. We aim to clarify whether these associations are independent of potentially confounding factors. We will also explore the association between POD and incident dementia.Methods and analysisThis study will recruit 200 patients from the ongoing Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study. Patients who live ≤45 miles from the study centre or have a planned visit to the centre 10–16 months postoperatively will be eligible. Patients with POD, measured by the Confusion Assessment Method, will be compared with patients without delirium. The primary outcome of cognitive function and secondary outcomes of quality of life and incident dementia will be compared between cohorts. Cognition will be measured by Trails A and B and Stroop Color and Word Test, quality of life with Veteran’s RAND 12-item Health Survey and incident dementia with the Short Blessed Test. Multivariable regression analyses and a Cox proportional hazards analysis will be performed. All results will be reported with 95% CIs and α=0.05.Ethics and disseminationThe study has been approved by the Washington University in St. Louis Institutional Review Board (IRB no 201601099). Plans for dissemination include scientific publications and presentations at scientific conferences.Trial registration numberNCT02241655.