The temporal relationship between early postoperative delirium and postoperative cognitive dysfunction in older patients: a prospective cohort study.
The temporal relationship between early postoperative delirium and postoperative cognitive dysfunction in older patients: a prospective cohort study.
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DOI：
10.1007/s12630-014-0242-6
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Leung J
中科院分区：
文献类型：
--
作者：
Youngblom E;DePalma G;Sands L;Leung J
术后妄想和认知功能障碍在老年患者中是常见的现象；然而，很少有研究研究这两种情况在术后早期的时间关系。因此，本研究旨在确定大型非心脏手术后是否存在术后精神障碍和术后认知功能障碍(POCD)。这是一项对65岁接受非心脏手术的≥患者进行的前瞻性队列研究。患者分别在手术前和术后两天进行精神障碍和POCD的评估。使用混淆评估方法确定精神错乱，通过三项认知测试来测量POCD，这些测试涉及执行功能、记忆、注意力和注意力的变化。对于术后的每一天，患者的神经状态被分为三种相互排斥的类型：精神错乱、POCD或两者都不存在。本文研究了461例65岁≥患者，其中421例接受了完整的术后认知测试。80%的患者在手术后第一天出现精神错乱或POCD。在术后第一天出现妄想的患者中，有70%的患者在术后第二天也出现了妄想。术后第一天患有POCD的患者中，有63%的患者第二天继续患有POCD。在第一天出现精神错乱的患者中，有16%在第二天没有神志不清，但在第二天达到了POCD的标准。相反，第一天患有POCD的患者中有15%在第二天变得神志不清。只有13%的患者在手术后的任何一天都没有经历精神错乱或POCD。80%的手术患者在手术后第二天经历了某种形式的认知功能障碍，很少有人在手术后第二天恢复。
Postoperative delirium and cognitive dysfunction are frequent phenomena in older patients; however, few studies have examined the temporal relationship between these two conditions in the early postoperative period. Therefore, this study aimed to determine if postoperative delirium and postoperative cognitive dysfunction (POCD) coexist after major noncardiac surgery. This was a prospective cohort study of patients who were ≥ 65 yr of age undergoing noncardiac surgery. Patients were evaluated preoperatively and for two days postoperatively for delirium and POCD. Delirium was determined using the Confusion Assessment Method, and POCD was measured by three cognitive tests addressing changes in executive function, memory, attention, and concentration. For each postoperative day, patients’ neurologic status was categorized into three mutually exclusive categories: delirium, POCD, or neither condition. Four hundred sixty-one patients aged ≥ 65 yr of age were studied, and 421 patients with complete postoperative cognitive testing were reported. Eighty percent of patients experienced either delirium or POCD on the first day after surgery. Seventy percent of patients who had delirium on the first postoperative day also had delirium on the second postoperative day. Sixty-three percent of patients who had POCD on postoperative day one continued to have POCD on the next day. Sixteen percent of patients with delirium on day one were non-delirious on day two but met criteria for POCD on day two. Conversely, 15% of patients with POCD on day one became delirious on day two. Only 13% of patients did not experience delirium or POCD on either day after surgery. Eighty percent of surgical patients experienced some form of cognitive dysfunction the day after surgery, and few recovered by the second day after surgery.
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影响因子：
8.8
作者：
Flink BJ;Rivelli SK;Cox EA;White WD;Falcone G;Vail TP;Young CC;Bolognesi MP;Krystal AD;Trzepacz PT;Moon RE;Kwatra MM
通讯作者：
Kwatra MM
影响因子：
5.7
作者：
Lopez, Oscar L;Kuller, Lewis H
通讯作者：
Kuller, Lewis H
影响因子：
4.6
作者：
BLUMENTHAL, JA;MAHANNA, EP;NEWMAN, MF
通讯作者：
NEWMAN, MF
影响因子：
9
作者：
Böhner, H;Hummel, TC;Schneider, F
通讯作者：
Schneider, F
影响因子：
2.1
作者：
Keizer, AMA;Hijman, R;van Dijk, D
通讯作者：
van Dijk, D