经典高分文献阅读·葡萄牙老年患者术前认知能力、局部脑氧饱和度和术后谵妄的相关性

BACKGROUND: Postoperative delirium is common among older patients and preoperative identification of high-risk patients is widely recommended. The aim of this study was to assess whether preoperative cognitive performance using brief screening tools or regional cerebral oxygen saturation (Scto2) was associated with the development of postoperative delirium in older Portuguese patients undergoing elective surgery.

背景：术后谵妄常见于老年患者，所以极力推荐在术前鉴别高危患者。本研究的目的是评估接受择期手术的葡萄牙老年患者术前认知能力（使用简单的筛选工具进行评估）或区域脑氧饱和度(Scto2)是否与术后谵妄的发生有关。

METHODS: Prospective observational cohort study where preoperative cognitive screening tools (Mini-Cog, Mini-Mental State Examination, verbal fluency) and Scto2 (INVOS 5100C; Medtronic, Ireland) were assessed in 238 patients ≥65 years old undergoing elective surgery between July 2017 and May 2019 at a tertiary academic center in Portugal. The primary outcome was postoperative delirium detected by the 3D-Confusion Assessment Method. Data were analyzed by univariate analysis and multivariable logistic regression.

方法:使用前瞻性队列研究，采用术前认知筛查工具(Mini-Cog,简易智力状态检查,语言流畅性)和监测Scto2工具(INVOS 5100C;Medtronic, Ireland)对2017年7月至2019年5月期间在葡萄牙一所高等学术中心接受择期手术的238名≥65岁患者进行了评估。主要结果是用3D-Confusion Assessment Method检测术后谵妄。数据采用单因素分析和多因素logistic回归分析。

注：前瞻性队列研究：是队列研究的基本形式。研究对象的分组是根据研究对象现时的暴露状况而定的，此时研究的结果还没有出现，需要前瞻性观察一段时间才能得到

Table&Figure

table1 基线特征及术后谵妄的单变量分析

table2 多变量Logistic回归模型研究Mini-Cog测试出的可能的认知障碍与术后谵妄之间的关系

table3 多变量Logistic回归模型研究MMSE测试出的可能的认知障碍与术后谵妄之间的关系

table4 多变量Logistic回归模型研究AVFT测试出的可能的认知障碍与术后谵妄之间的关系

table5 多变量Logistic回归模型研究术前局部脑氧饱和度与术后谵妄之间的关系

table6  完成正规教育年限与Mini-Cog、MMSE和动物语言流利测试原始分数之间的Spearman相关系数

RESULTS: Delirium was identified in 53 patients (22%); 162 patients (68%) had completed only 4 years of education. On multivariable analysis, probable cognitive impairment tested by the Mini-Cog (odds ratio [OR] = 1.57; 95% confidence interval [CI], 0.70–3.53; corrected P value >.999), by the Mini-Mental State Examination (OR = 2.75; 95% CI, 1.23–6.13; corrected P value = .052), and by the animal verbal fluency test (OR = 1.24; 95% CI, 0.49–3.16; corrected P value >.999) were not significantly associated with the development of postoperative delirium. In contrast, lower preoperative Scto2 (OR = 1.08; 95% CI, 1.02–1.14; corrected P value = .024 for each point decrease in Scto2) was associated with postoperative delirium.

结果:（本研究共纳入238名患者）53例(22%)患者出现谵妄;162名患者(68%)仅完成了4年的教育。在多变量分析中，通过Mini-Cog测试出的可能的认知障碍(OR0.91; 95%CI : 0.70-3.53; 校正P值>.999)，简易智力状态检查测试出的可能的认知障碍(OR2.75; 95%CI : 1.23-6.13 ; 校正P值>.999)，以及语言流畅性测试出的可能的认知障碍(OR1.24;95%CI : 0.49-3.16 ; 校正P值>.999)与术后谵妄的发生无显著相关性。相比之下，术前Scto2较低(1.08; 95%CI : 1.02-1.14; Scto2每降低1，校正P值= .024)与术后谵妄相关。

CONCLUSIONS: We did not find enough evidence to suggest that poor preoperative cognitive performance was significantly associated with the development of postoperative delirium in an older Portuguese surgical population with an overall low level of formal education, but rather that preoperative Scto2 may be helpful in identifying patients at risk for delirium.

结论：我们发现无足够的证据表明在整体正规教育水平较低的葡萄牙老年外科患者中，术前认知能力差与术后谵妄的发生有显著相关性。然而术前Scto2可能有助于识别有谵妄风险的患者。

所属分类：首页 > SCI期刊 > 医学

国际刊号：0003-2999

2020年影响因子/JCR分区：4.305/Q2

出版国家或地区：UNITED STATES

出版周期：Monthly

出版年份：1957

年文章数：425

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