“基本认知能力测验”对老年人术后认知功能的评估  

Evaluative effect of basic cognitive capability test for postoperative cognitive dysfunction in elderly patients

作　　者：缪慧慧[1] 张滨[1] 洪方晓[1] 丁冠男[1] 田鸣[1] 

机构地区：[1]北京友谊医院麻醉科,100050

出　　处：《国际麻醉学与复苏杂志》2009年第1期24-26,共3页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较“基本认知能力测验”软件（2．0版）与由国际术后认知功能障碍研究协作组（International study of postoperative cognitive dysfunction，ISPOCD）推荐的测验方法对老年人术后认知功能障碍（postoperative cognitive dysfunction．POCD）的评估效果，并研究两种方法分测验之间的相关性。方法由同一专人采用两种方法分别于术前1d、术后7d、术后3个月对131例60岁-80岁，择期行非心脏手术的老年人进行认知功能的评估。同时设立对照组，30例未行手术的健康老年人，于相同时间间隔完成上述两套测验。“基本认知能力测验”（方法A）包括数字拷贝（A1），心算（A3）等，ISPOCD推荐的测验组合（方法B）包括连线测验（B1），符号数字模式测验（B2）等。两套测验的原始数据均采用Z计分法，Z≥2时判断患者发生了POCD。结果①131例入选患者中，120例完成术后7d测验，67例完成术后3个月测验。②术后7dPOCD检出率，方法A和方法B无统计学差异（分别为12．5％与10．8％，P＞0．05）；术后3个月POCD检出率亦无统计学差异（分别为5．97％与7．46％，P＞0．05）。③两种方法在术后7d和术后3个月对POCD的评估效果是一致的，Kappa为0．758与0．881，P＜0．05。④术后7d和术后3个月两种方法的组合“Z”计分之间均呈显著正相关（r为0．316与0．302，P＜0．05）。⑤在认知速度方面，数字拷贝（A1）与连线测验（B1）有显著相关性（r为0．517，P＜0．05）。在学习及工作能力方面，心算效率（A3）与符号数字模式测验（B2）有显著相关性（r为0．52，P＜0．05）。结论“基本认知能力测验”与ISPOCD推荐的测验方法对老年人POCD的评估效果相同。“基本认知能力测验”软件实用性强，在国人POCD评估方面具有临床应用价值。Objective To compare basic cognitive capability test （version 2.0） with the method recommended by ISPOCD （ international study of postoperative cognitive dysfunction） on the evaluation of postoperative cognitive dysfunction （POCD） in elderly patients, and study the correlation of two different methods. Methods Two neuropsychological tests were performed preoperatively, and postoperatively on Day 7 and 3 months upon 131 elderly patients undergoing elective major non-cardiac surgery and 30 healthy elderly volunteers that were set as a control group. One was Basic Cognitive Capability Test （Method A）, including digit copying （A1）, mental arithmetic （ A3 ）, et al. However, The other was recommended by ISPOCD （ Method B ）, including trail making test （ B1 ）, digit symbol sub-test （B2）, et al. Z score was used to analyze the data. POCD was defined as Z score ≥2. Results ① 120 Out of 131 patients had completed the tests on Day 7 postoperatively, and then 67 among them had finished the tests 3 months postoperatively. ②The incidence rate of POCD on Day 7 was （ 12.5% and 10. 8%, P 〉0.05 ） ; and at 3 months was （5.97% and 7.46%, P 〉 0.05）. ③ Two methods were consistent for evaluation of POCD on Day 7 and 3 months postoperatively. Kappa were 0. 758 and 0.881, P 〈0.05. ④ Both on Day 7 and 3 months, the combined Z score of Method A and Method B had significant correlation, r = 0. 316 and 0.302,P 〈 0.05. ⑤As for speed of recognition, digit copying （ A1 ） vs. trail making test （ B1 ） had significant correlation, r = 0.517, P 〈 0.05. For ability of study and performance, mental arithmetic （A3） vs. digit symbol subtest （B2） had significant correlation, r = 0.52, P 〈 O. 05. Conclusion Basic cognitive capability test was consistent with tests recommended by ISPOCD for evaluation of POCD. Basic cognitive capability test using computer was more objective, accurate and beneficial for clinical practice.

关 键 词：POCD 基本认知能力测验 神经心理学测验 

分 类 号：R614[医药卫生—麻醉学]