Postoperative cognitive dysfunction in middle-aged patients
Postoperative cognitive dysfunction in middle-aged patients
复制标题
中年患者术后认知功能障碍
DOI：
10.1097/00000542-200206000-00014
复制
发表时间：
2002-06-01
期刊：
影响因子：
8.8
通讯作者：
Moller, JT
中科院分区：
文献类型：
--
作者：
Johnson, T;Monk, T;Moller, JT
背景：非心脏手术后的术后认知功能障碍（POCD）与老年患者年龄增长密切相关；中年患者（40-60 岁）的发病率可能较低，尽管主观主诉很常见。 方法：作者使用一系列神经心理学测试，比较了 40-60 岁患者在第 1 周和第 3 个月的神经心理学测试结果的变化，与年龄匹配的对照受试者使用 Z 评分分析的结果进行了比较。他们评估了 POCD 的危险因素以及与主观认知功能、抑郁和日常生活活动的相关性。结果：7 天时，19.2%（置信区间 [CI]，15.7-23.1）的患者和 4.0%（CI，1.6-8.0）的对照受试者存在定义的认知功能障碍（P < 0.001）。 3 个月后，患者的发病率为 6.2%（CI，4.1-8.9），对照受试者的发病率为 4.1%（CI，1.7-8.4）（不显着）。 7 天时的 POCD 与补充硬膜外镇痛和报告的避免饮酒有关。 3 个月时，29% 的患者出现 POCD 主观症状，这一发现与抑郁症相关。早期 POCD 与 3 个月时活动评分较低的报告相关。结论：术后认知功能障碍频繁发生，但在术后 3 个月内消失。这可能与此期间活动减少有关。主观报告高估了 POCD 的发生率。患者认识到问题是真实存在的，并确信问题可能只是暂时的，这可能会对患者有所帮助。
Background: Postoperative cognitive dysfunction (POCD) after noncardiac surgery is strongly associated with increasing age in elderly patients; middle-aged patients (aged 40-60 yr) may be expected to have a lower incidence, although subjective complaints are frequent.Methods: The authors compared the changes in neuropsychological test results at I week and 3 months in patients aged 40-60 yr, using a battery of neuropsychological tests, with those of age-matched control subjects using Z-score analysis. They assessed risk factors and associations of POCD with measures of subjective cognitive function, depression, and activities of daily living.Results: At 7 days, cognitive dysfunction as defined was present in 19.2% (confidence interval [CI], 15.7-23.1) of the patients and in 4.0% (CI, 1.6-8.0) of control subjects (P < 0.001). After 3 months, the incidence was 6.2% (CI, 4.1-8.9) in patients and 4.1% (CI, 1.7-8.4) in control subjects (not significant). POCD at 7 days was associated with supplementary epidural analgesia and reported avoidance of alcohol consumption. At 3 months, 29% of patients had subjective symptoms of POCD, and this finding was associated with depression. Early POCD was associated with reports of lower activity scores at 3 months.Conclusions: Postoperative cognitive dysfunction occurs frequently but resolves by 3 months after surgery. It may be associated with decreased activity during this period. Subjective report overestimates the incidence of POCD. Patients may be helped by recognition that the problem is genuine and reassured that it is likely to be transient.