三种评判标准对非心脏手术患者术后认知功能障碍评估的比较  

Comparison of the three kind of criteria to evaluate the incidences of postoperative cognitive dysfunction in non-cardiac surgery in non-cardiac surgery

作　　者：方开云[1] 何祥[1] 朱焱[2] 尚杰[2] 宋开莲[2] 莫怀忠[3] 史静[4] 刘卫华[1] 

机构地区：[1]贵州省人民医院麻醉科,贵阳市550002 [2]贵阳医学院公共卫生学院卫生统计学教研室 [3]贵阳医学院附属肿瘤医院麻醉科 [4]贵阳医学院附属医院麻醉科

出　　处：《临床麻醉学杂志》2014年第6期564-567,共4页Journal of Clinical Anesthesiology

基　　金：贵州省自然科学基金(黔科合J字[2008]2305);贵州省科技厅(黔科合SY字[2011]009);贵州省社会发展公关项目(黔科合SY字[2012]3111)

摘　　要：目的比较三种评判标准对非心脏手术患者术后认知功能障碍(POCD)发生率的评估。方法随机选择非心脏手术患者461例为研究组,同期住院非手术患者244例作为对照组,用MMSE对两组患者进行术前、术后1 d及术后3 d认知功能测试,所得分值分别采用受教育程度法、Z计分法和1个标准差法(1SD法)对术后认知功能进行评定。结果术后1d和3d,Z计分法对POCD的检出率和95%的可信区间最高,受教育程度法最低;术后1d和3d受教育程度法阳性、Z计分法阴性分别有1例和4例。结论不同的评判标准可使同一组病例POCD的发生率显著不同,在对认知功能评判的研究中Z计分法更具合理性,可以较大程度地避免了POCD的漏诊。Objective Compare the three kind of criteria in evaluating the incidences of postoperative cognitive dysfunction in non-cardiac surgery. Methods Four hundred and sixty one non-cardiac surgery patients were randomly enrolled in this study group and two hundred forty four non-surgery patients as control group. Patients＇ cognitive state was measured on preoperative and postoperative 1 and 3 d by mini-mental state examination（MMSE）. POCD was assessed by patients＇ education level, one standard deviation and Z-score scale, respectively. Results On the first and third day after surgery,Z-score scale assess POCD result showed the highest relevance ratio and 95% CI as well as the lowest education level. The education scale showed the lowest incidence of POCD. Education level criteria was positive on postoperative 1 and 3 day, while one case on postoperative 1 day and four cases on postoperative 3 day were negative by Z-score scale. Conclusion The incidence of POCD in same patients by three kind of criteria are different. The Z-score scale is recommended to evaluate the POCD in order to avoid misdiagnosis.

关 键 词：术后认知功能障碍 心脏手术 术后并发症 

分 类 号：R614[医药卫生—麻醉学]