非心脏手术患者术前焦虑和抑郁状态与术后神经认知功能恢复延迟的相关性

Association between preoperative anxiety and depression with delayed neurocognitive recovery after operation in non-cardiac surgery patients

目的分析全麻患者术前焦虑和抑郁状态与术后神经认知功能恢复延迟(DNR)的相关性。方法选择2018年11月至2020年6月择期行全麻非心脏手术患者436例,男231例,女205例,年龄50~80岁,BMI 19~33 kg/m^(2),ASAⅠ—Ⅲ级。术前分别采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估焦虑和抑郁状态。分别于术前1 d、术后30 d对患者进行神经心理学测试,采用Z分法来判定术后是否发生DNR。根据是否发生DNR将患者分为两组:DNR组(n=44)和无DNR组(nDNR组,n=392)。记录患者性别、年龄、受教育程度、术前合并症等,采用单因素和多因素logistic回归分析,采用Spearman相关分析不同焦虑、抑郁程度与术后DNR的相关性。结果术前焦虑和抑郁状态的发生率分别为58.4%和43.2%。术后DNR的发生率为10.2%。Logistic回归分析显示,术后DNR的危险因素包括年龄增加(OR=2.651,95%CI 1.586~5.756)、术前抑郁(OR=1.687,95%CI 1.144~2.659)和麻醉时间延长(OR=1.231,95%CI 1.100~2.213)。结论全麻患者术前抑郁状态是术后30 d发生术后神经认知功能恢复延迟的独立危险因素,与术后神经认知功能恢复延迟明显正相关。

Objective To analyze the association between preoperative anxiety and depression with delayed neurocognitive recovery(DNR)in non-cardiac surgery patients under general anesthesia.Methods A total of 436 patients underwent non-cardiac surgery under general anesthesia was enrolled from November 2018 to June 2020,231 males and 205 females,aged 50-80 years,BMI 19-33 kg/m^(2),ASA physical statusⅠ-Ⅲ.Evaluated preoperative depression by self-rating depression,and investigated preoperative anxiety using the Generalized Anxiety Disorder 7-item scale 1 day before surgery.Z-score was used to assess neurocognitive disorder on day 1 before operation and on day 30 after operation,respectively.According to state of DNR,patients were divided into two groups:DNR group(n=44)and non-DNR group(nDNR group,n=392).The general data of patients,preoperative complications and types of surgery were recorded.If there was significant difference between the two groups,the factor was analyzed using multi-factor logistic regression to select the risk factor for incidence of DNR after operation.Results The incidence of pre-anesthesia depression and anxiety was 58.1%and 34.2%,respectively.The incidence of delayed neurocognitive recovery after operation was 10.2%in 436 patients underwent general anesthesia.The results of logistic regression analysis showed that the dangerous degree of the risk factors for DNR after operation were age increased(OR=2.651,95%CI 1.586-5.756),depression before operation(OR=1.687,95%CI 1.144-2.659),and duration of anesthesia prolonged(OR=1.231,95%CI 1.100-2.213).Conclusion Depression before surgery is an independent risk factor for delayed neurocognitive recovery in patients under general anesthesia,and significantly positive correlated with delayed neurocognitive recovery.