非心脏手术老年患者术前衰弱与术后认知功能障碍的关系

Relationship between preoperative frailty and postoperative cognitive dysfunction in elderly patients undergoing non-cardiac surgery

目的:评价非心脏手术老年患者术前衰弱与术后认知功能障碍(POCD)的关系。方法:择期全麻下行非心脏手术老年患者336例,年龄≥65岁,性别不限,ASA分级Ⅱ或Ⅲ级,BMI 18.6~25.1 kg/m^(2)。于术前1 d时采用临床衰弱量表评估患者衰弱情况。于术前1 d和术后1、7、30 d时行简易精神状态检查量表评分、数字广度测试、数字符号转换测试、Stroop色词测试、视觉词语学习测试和循迹连线测试,采用Z计分法判定POCD。根据术后30 d内是否发生POCD分为非POCD组和POCD组。采用logistic回归分析筛选非心脏手术老年患者POCD的危险因素。结果:logistic回归分析结果表明,术前衰弱和合并糖尿病是非心脏手术老年患者POCD的独立危险因素(P<0.05)。结论:术前衰弱是非心脏手术老年患者POCD的独立危险因素。

Objective To evaluate the relationship between preoperative frailty and postoperative cognitive dysfunction(POCD)in elderly patients undergoing non-cardiac surgery.Methods A total of 336 elderly patients of both sexes,aged≥65 yr,of American Society of Anesthesiologists physical statusⅡorⅢ,with body mass index of 18.6-25.1 kg/m^(2),undergoing elective non-cardiac surgery under general anesthesia,were enrolled in the study.Faltering status was assessed with the Clinical Faltering Scale at 1 day before surgery.Mini-Mental State Examination score,Digital Span Test,Digit Symbol Substitution Test,Stroop Color and Word Test,Visual Word Learning Test and Trail Making Test were performed at 1 day before surgery and at 1,7 and 30 days after surgery.The Z score was used to identify POCD.The patients was divided into non-POCD group and POCD group according to the occurrence of POCD within 30 days after surgery.Logistic regression analysis was used to identify the risk factors for POCD in elderly patients undergoing non-cardiac surgery.Results The results of logistic regression analysis showed that preoperative frailty and diabetes mellitus were independent risk factors for POCD in elderly patients undergoing non-cardiac surgery(P<0.05).Conclusion Preoperative frailty is an independent risk factor for POCD in elderly patients undergoing non-cardiac surgery.