老年患者术后谵妄与术后认知功能障碍的相关性研究  

The relation of postoperative delirium and postoperative cognitive dysfunction

作　　者：张帅[1] 张滨[1] 洪方晓[1] 张晔[1] 缪慧慧[1] 张静[1] 田鸣[1] 李树人[1] 

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,100050

出　　处：《北京医学》2009年第10期588-590,共3页Beijing Medical Journal

摘　　要：目的分析老年非心脏手术患者术后谵妄(POD)与术后早期认知功能障碍(POCD)之间的关系,探讨POD发病的围术期危险因素。方法对2008年9～12月182例行择期非心脏手术的老年患者(≥60岁,除外老年痴呆、严重肝肾功能不全、严重中枢神经系统疾病的患者)进行术前精神心理量表测验。POD采用《精神疾病诊断与统计手册》的标准进行诊断,POCD以国际术后认知功能障碍研究协作组(ISPOCD)推荐的标准进行诊断。术前及术后第1、3天对患者进行POD评估,术前及术后7d对患者进行POCD的神经心理测验。结果172例患者最终完成了术后第3天的谵妄评估,其中有26例发生POD(谵妄组),发生率为15.1%。138例患者完成了术后第7天的神经心理测验,28例发生POCD,发生率为20.3%。谵妄组中23例完成第7天心理测验,其POCD的发生率(10/23,43.5%)明显高于非谵妄组(18/115,15.7%)。多因素Logistic逐步回归分析结果显示,高血压病史、受教育年数、入室血压、插管后呼气末二氧化碳分压(PetCO2)、术中最低红细胞压积(Hct)、麻醉时间和术后血糖等为术后谵妄的危险因素。结论发生POD的老年患者更易出现早期POCD;高血压病史、受教育年数、麻醉时间及术中最低Hct等因素与老年患者POD的发生有关。Objective To observe the incidence of postoperative delirium （POD）and the relation of POD and early postoperative cognitive dysfunction（POCD）in elderly noncardiac surgical patients. To analyze the perioperative risk factors of POD. Methods From September to December in 2008, our study had recruited 282 elderly subjects undergoing elective, noncardiac surgery postoperatively. In which the patients had been depleted with Alzheimer disease （AD）, failure of hepatic or renal function, and central nervous system disease. 182 subjects underwent neuropsychological testing for POD and POCD. For the diagnostic criteria, POD was according to the Diagnostic and Statistical Manual and POCD was according to the criteria of ISPOCD. Patients were tested preoperatively and 1st, 3rd days postoperatively for POD and preoperatively and 7th day postoperatively for POCD. Results Totally 172 patients finished the 3rd day’s assessment. POD occurred in 26 patients. The incidence of POD was 15.1%. 138 patients in all finished the 7th day’s assessment. POCD occurred in 28 patients. The incidence of POCD was 20.3%. The incidence of POCD in Delirium group （10/23, 43.5%） was higher than that in Nondelirium group （18/115, 15.7%）. The Logistic stepwise regression analysis indicated that the perioperative risk factors of POD were history of hypertension, educational level, lowest Hct during the operation, duration of operation and postoperative hyperglycemia. Conclusions The patients with POD are prone to early POCD. Hypertension, educational level, lower Hct during operation and postoperative hyperglycemia are risk factors of POD.

关 键 词：老年 术后 谵妄 认知功能障碍 

分 类 号：R619[医药卫生—外科学] R749.161[医药卫生—临床医学]