简易智能状态量表在术后谵妄患者认知评估中的应用

Application of MMSE in postoperative delirium patients after neurosurgery

目的探讨简易智能状态量表(mini-mental state examination,MMSE)在神经外科术后谵妄(postoperative delirium,POD)患者认知障碍评估中的应用。方法于2017年4—8月采用目的抽样法,应用ICU意识模糊评估法及意识模糊评估法筛查出复旦大学附属华山医院神经外科术后3 d内的谵妄的患者69例,采用MMSE评估患者认知障碍程度,分析MMSE量表应用于神经外科POD患者认知障碍评估的信效度及可行性,并分析不同亚型POD患者MMSE得分及认知障碍程度的差异。结果 MMSE应用于神经外科POD患者的Cronbach'sα系数为0. 70,理解力、书面表达、画图3个条目的因子载荷为0. 13、0. 23、0. 04,其余条目因子载荷为0. 46～0. 84。MMSE量表的有效回收率为100%,理解力、书面表达、画图条目完成率低于85%,其余条目完成率均为100%。神经外科POD患者MMSE得分为(12. 48±5. 81)分,活跃型谵妄与安静型谵妄患者MMSE得分及认知功能障碍程度差异均无统计学意义(P>0. 05)。结论 MMSE应用于神经外科POD患者的信度较佳,但效度欠佳,可行性存在一定局限。应用其评估使用保护性约束的POD患者,尤其是活跃型POD患者时应重点关注患者安全,防止非计划性拔管等不安全事件的发生;或使用MMSE时严格控制应用人群,以充分预测谵妄,有效评估谵妄患者的认知障碍程度。

Objective To analyze the application of mini-mental state examination( MMSE) in postoperative delirium( POD) patients after neurosurgery. Methods The confusion assessment method for the intensive care unit( CAM-ICU) and CAM were used to diagnose delirium in the patients within 3 d after neurosurgery.Purpose sampling was used to enroll POD patients in Huashan Hospital,Fudan University from April to August2017,and MMSE was used to evaluate POD degree. The reliability,validity and feasibility of MMSE were analyzed. t-test was used to analyze the difference in MMSE score between hypoactive and hyperactive delirium,and Chi-square test was used to analyze the difference in cognitive impairment. Results The Cronbach’ s αcoefficient was 0. 70,the loadings of comprehension,writing and drawing were 0. 13,0. 23,0. 04,and the other items’ loadings were 0. 46-0. 84. The complete rates of comprehension,writing and drawing were less than 85%,while those of other items were 100%. The average MMSE score was 12. 48 ± 5. 81 in POD patients. There was no statistical difference in MMSE score and cognitive impairment between hyperactive delirium and hypoactive delirium. Conclusion The reliability of MMSE applied in POD patients is good,but the validity and feasibility are not good enough.There are some limitations in patient safety when MMSE is applied in POD patients,especially hyperactive delirium patients using physical restraint. The inclusive criteria also need strict control to fully predict the severity of delirium and cognitive impairment.