主观认知下降对术后谵妄的预测价值  

Predictive value of subjective cognitive declineon postoperative delirium

作　　者：孙强[1] 吴波[1] 茆梦 王菲 纪木火 SUN Qiang;WU Bo;MAO Meng;WANG Fei;JI Mu-huo(Jiangsu Province Key Laboratory of Oral Diseases,the Affiliated Stomatology Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Anesthesiology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学附属口腔医院江苏省口腔疾病研究重点实验室,江苏省南京市210029 [2]南京医科大学第二附属医院麻醉科,江苏省南京市210011

出　　处：《实用老年医学》2023年第2期156-159,共4页Practical Geriatrics

基　　金：南京医科大学科技发展基金资助项目(NUMB2020053)。

摘　　要：目的探讨主观认知下降(subjective cognitive decline,SCD)对术后谵妄的预测价值。方法纳入择期非心脏手术老年病人156例,术前1 d采用主观认知下降问卷(SCD-Q9)评估病人是否发生SCD,麻醉前采集外周静脉血测定血清相关标志物,术后1~3 d采用中文版意识模糊评估量表评估病人是否发生术后谵妄(postoperative delirium,POD),根据是否发生POD将病人分为POD组与非POD组。采用多因素Logistic回归分析POD发生的影响因素,绘制ROC曲线,并计算AUC分析SCD预测POD的价值。结果POD组病人SCD发生率、血清IL-6和神经丝轻链水平显著高于非POD组(P<0.05)。多因素Logistic回归分析显示,POD的危险因素为SCD(OR=1.952,95%CI:1.183~3.532,P<0.05)、高血清IL-6(OR=1.103,95%CI:1.052~1.154,P<0.05)。SCD与IL-6预测POD的AUC分别为0.768(95%CI:0.692~0.845,P<0.01)和0.865(95%CI:0.784~0.945,P<0.01)。结论术前SCD是POD的危险因素,对POD的发生具有较高的预测价值。Objective To explore the predictive value of subjective cognitive decline(SCD)on postoperative delirium(POD).Methods A total of 156 elderly patients scheduled foRnon-cardiac surgeries were selected.The development of SCD was assessed by Subjective Cognitive Decline Questionnaire(SCD-Q9)one day before surgery.Peripheral venous blood samples were collected to detect the levels of serum biomarkers before anesthesia induction.The patients received POD assessment using Chinese version of Confusion Assessment Method 1-3 d afteRoperation.Then the patients were divided into the POD group and the non-POD group.Multiple Logistic regression analysis was used to analyze the risk factors foRPOD.The receiveRoperating characteristic curve(ROC)was drawn and the area undeRthe curve(AUC)was calculated to evaluate the predictive value of SCD on POD.Results Compared with the non-POD group,the incidence of SCD,serum levels of interleukin-6(IL-6)and neurofilament light were significantly increased in the POD group(P<0.05).Logistic regression analysis showed that SCD(OR=1.952,95%CI:1.183-3.532,P<0.05)and preoperative serum IL-6(OR=1.103,95%CI:1.052-1.154,P<0.05)were the risk factors foRthe development of POD.Preoperative SCD and serum IL-6 showed an AUC of 0.768(95%CI:0.692-0.845,P<0.001)and 0.865(95%CI:0.784-0.945,P<0.001)to predict POD respectively.Conclusions Preoperative SCD is a significant risk factoRfoRPOD,which could be used to predict the incidence of POD.

关 键 词：认知功能 手术 老年人 谵妄 危险因素 

分 类 号：R749.2[医药卫生—神经病学与精神病学]