Prediction of postoperative delirium after abdominal surgery in the elderly
Prediction of postoperative delirium after abdominal surgery in the elderly
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DOI：
10.1007/s00540-008-0688-1
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发表时间：
2009-02-01
影响因子：
2.8
通讯作者：
Sakabe, Takefumi
中科院分区：
文献类型：
--
作者：
Morimoto, Yasuhiro;Yoshimura, Manabu;Sakabe, Takefumi
目的。老年患者手术治疗的适应症越来越多。术后中枢神经系统功能障碍，包括谵妄，是老年外科患者最常见的并发症之一。评价脑氧饱和度等患者因素与术后谵妄发生率的关系。20例美国麻醉医师协会（ASA）身体状态I-II的患者，年龄大于65岁，计划择期腹部手术纳入研究。术前及术后1周分别采用Hasegawa痴呆评分（HDS）和kana-hiroi测试对患者的认知功能进行评估。术中使用近红外光谱（INVOS 3100）连续监测局部脑氧饱和度（rSO(2)）。用3 mg.kg（-1）硫喷妥钠和5%七氟醚诱导全身麻醉。气管插管后调整多氯丙烷浓度，使双谱指数（BIS）维持在45 ~ 60之间。如果符合DSM IV标准，且患者在谵妄评定量表上得分12分或以上，则诊断为术后谵妄。术后5例（25%）患者出现谵妄。谵妄（+）组（76 +/- 4岁）明显高于谵妄（-）组（68 +/- 3岁）。术前和术后HDS组间无差异。谵妄（+）组术前kana-hiroi-test评分（16 +/- 5）明显低于谵妄（-）组（32 +/- 10）。两组患者术前和术后假名-广氏测验得分均无显著差异。谵妄（+）组基线rSO(2)（60 +/- 5%）显著低于谵妄（-）组（66 +/- 7%）。然而，手术开始后两组间的rSO(2)无显著差异。患者年龄、术前kana-hiroi评分低、术前rSO(2)低是术后谵妄发生的重要危险因素。
Purpose. Indications for the surgical treatment of elderly patients have been increasing. Postoperative central nervous system dysfunction, including delirium, is one of the most common complications in elderly surgical patients. The relationship between patient factors, including cerebral oxygen saturation, and the incidence of postoperative delirium was evaluated.Methods. Twenty American Society of Anesthesiologists (ASA) physical status I-II patients, older than 65 years, scheduled for elective abdominal surgery were enrolled in the study. The patients' cognitive function was assessed, using the Hasegawa dementia score (HDS) and kana-hiroi test, on the day before surgery and then again 1 week after the surgery. Regional cerebral oxygen saturation (rSO(2)) was continuously monitored during the surgery, using near-infrared spectroscopy ( INVOS 3100). General anesthesia was induced with 3 mg.kg(-1) thiopental and 5% sevoflurane. After tracheal intubation, the sevofl urane concentration was adjusted to maintain the bispectral index (BIS) value between 45 and 60. Postoperative delirium was diagnosed if DSM IV criteria were present and the patient scored 12 or more points on the Delirium Rating Scale.Results. After surgery, 5 (25%) patients developed delirium. The age in the delirium (+) group ( 76 +/- 4 years) was significantly higher than that in delirium (-) group ( 68 +/- 3 years). Preoperative and postoperative HDS did not differ between the groups. The score on the preoperative kana-hiroi-test in the delirium (+) group (16 +/- 5) was significantly lower than that in the delirium (-) group ( 32 +/- 10). There were no significant differences between preoperative and postoperative kana-hiroi test scores in either group. Baseline rSO(2) in the delirium (+) group ( 60 +/- 5%) was significantly lower than that in the delirium (-) group ( 66 +/- 7%). However, there were no significant differences between the groups in the rSO(2) after the start of surgery.Conclusion. Patients' age, low preoperative kana-hiroi test score, and low preoperative rSO(2) were important risk factors for postoperative delirium.