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Ann Surg:术后认知障碍是否与手术及麻醉相关?

2017-05-14 MedSci MedSci原创

术后认知功能障碍是一种普遍存在的个体和公共健康问题。但是关于其研究的数据较少不足以确定认知障碍是否是由于手术和麻醉的暴露相关。本研究旨在确定手术和麻醉是否是重症疾病患者术后(非心脏术)认知功能障碍的一个独立的危险因素。 采用多中心的前瞻性队列研究设计,纳入ICU重症患者,住院期间接受非心脏手术或未接受手术治疗。在第3个月和12个月,使用重复性成套神经心理状态测验评估幸存者的整体认知功能,并使

术后认知功能障碍是一种普遍存在的个体和公共健康问题。但是关于其研究的数据较少不足以确定认知障碍是否是由于手术和麻醉的暴露相关。本研究旨在确定手术和麻醉是否是重症疾病患者术后(非心脏术)认知功能障碍的一个独立的危险因素。

采用多中心的前瞻性队列研究设计,纳入ICU重症患者,住院期间接受非心脏手术或未接受手术治疗。在第3个月和12个月,使用重复性成套神经心理状态测验评估幸存者的整体认知功能,并使用连线测验B式评估其执行能力。使用多元线性回归分析探究手术/麻醉暴露与认知结果之间的关系,校正初始基线时期的协变量和随后住院的协变量。

研究共纳入了1040名患者,其中402(39%)名接受手术/麻醉暴露。手术和麻醉暴露的患者与未暴露的患者在第3个月(79 VS 80)和12个月(82 vs 82)时整体认知评分中位数相似。此外,中位执行功能评分在3个月(41 VS 40)和12个月(43 vs 42)时也相似。手术/麻醉暴露与3或12个月时患者较差的整体认知或执行功能并无关联,分析已纳入基线或住院协变量(P>0.2)。较高的基线教育水平与3个月和12个月时更好的整体认知相关(P<0.001),较长的住院谵妄持续时间与3个月和12个月时较差的整体认知功能(P<0.02)和执行功能(P<0.01)相关。

总而言之,该研究发现,重症患者术后(非心脏病手术)以及危重病后认知障碍与手术和麻醉的暴露无关,但是却可由基线时的教育水平和住院患者谵妄来预测。

原始出处:

Hughes CG, Patel MB, et al., Surgery and Anesthesia Exposure Is Not a Risk Factor for Cognitive Impairment After Major Noncardiac Surgery and Critical Illness. Ann Surg. 2017 Jun;265(6):1126-1133. doi: 10.1097/SLA.0000000000001885.

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    2017-05-19 方舒

    学习

    0

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    2017-05-18 方舒

    学习

    0

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    2017-05-18 zhanjian

    手术麻醉不能排除吧,那为什么不做手术的同一患者没发生认知功能障碍呢?

    0

  4. 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    2017-05-16 克勤

    学习了

    0

  5. 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    2017-05-15 lou.minghong

    学习

    0

  6. 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    2017-05-14 xiaotaiyang1

    看看了解一下

    0

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    2017-05-14 Chongyang Zhang

    签到学习了很多。

    0

  8. 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    2017-05-14 一个尘埃

    学习了,谢谢分享。

    0

  9. 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    2017-05-14 wxl882001

    学习一下

    0

  10. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90f31612316, createdName=xiaotaiyang1, createdTime=Sun May 14 20:52:37 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=198060, encodeId=70ea19806049, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Sun May 14 17:29:35 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=198054, encodeId=447e198054aa, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eotHc7cjrVcIHD9L2n3LzcQo1WSYledtExBOM76QRXV0FrtWOsoLNA9xaJmBjsBFwPvC7fNarGfAg/132, createdBy=531e1939570, createdName=一个尘埃, createdTime=Sun May 14 16:51:58 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=198053, encodeId=701319805312, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Sun May 14 16:44:53 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=198051, encodeId=ea9419805116, content=这个研究明显是有偏倚的,虽然术后认知障碍到底是什么原因目前还不清楚,但手术和麻醉应该是两个重要的危险分子。而本研究认为是教育水平实在是可笑, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun May 14 16:04:11 CST 2017, time=2017-05-14, status=1, ipAttribution=)]
    2017-05-14 lovetcm

    这个研究明显是有偏倚的,虽然术后认知障碍到底是什么原因目前还不清楚,但手术和麻醉应该是两个重要的危险分子。而本研究认为是教育水平实在是可笑

    0

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