妇科肿瘤大手术患者术后认知能力下降:一项试点前瞻性研究

IF 2 Q2 OBSTETRICS & GYNECOLOGY
Mallika Makkar MD, HBSc , Rebekah Hunter MD , Anjali Kulkarni MD, MSc , Julie M.V. Nguyen MD, MSc
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引用次数: 0

摘要

背景:术后认知功能衰退(POCD)的特点是注意力、记忆力、执行功能和信息处理能力出现缺陷,并持续到术后早期以后。其发生率在非心脏手术后为 10%-25%。有关妇科肿瘤手术后 POCD 的文献有限:我们的主要目的是确定 55 岁及以上接受妇科肿瘤大手术的患者中 POCD 的发生率:这项混合方法、前瞻性、观察性队列研究对 2022 年 2 月至 7 月间接受妇科恶性肿瘤手术的 55 岁及以上患者进行了跟踪调查。研究人员在手术前、手术后 1 个月和 3 个月进行了半结构化访谈和迷你精神状态检查(MMSE)。评估是在 COVID-19 大流行的背景下以虚拟和面对面的方式进行的。与基线 MMSE 分数相比,POCD 的定义是下降≥ 2 分:24名患者参加了此次活动;19人完成了1个月的随访,15人完成了3个月的随访。平均年龄为 64 岁(范围:56-90 岁)。术前 MMSE 平均得分为 16.6(满分 17 分)(虚拟)和 12.9(满分 13 分)(面对面)。两名患者 1 个月的 MMSE 分数下降了 1 分;两人均在 3 个月后恢复。一名患者 3 个月的 MMSE 分数下降了 1 分。半结构式访谈揭示了共同的主题,即术后1个月随访时出现 "脑雾",术后3个月出现轻度、持续的注意力和文字查找障碍:这项研究的定性部分捕捉到了一些微妙的主观发现,提示了潜在的 POCD。需要进行更大规模的研究,而且可能需要更广泛的神经心理测试,以得出 MMSE 分数无法明确反映的细微结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postoperative Cognitive Decline in Patients Undergoing Major Gynecologic Oncology Surgery: A Pilot Prospective Study

Objectives

Postoperative cognitive decline (POCD) is characterised by deficits in attention, memory, executive function, and information processing that persist beyond the early postoperative period. Its incidence ranges from 10%–25% after noncardiac surgery. Limited literature exists on POCD after gynecologic oncology surgery. Our primary objective was to identify the incidence of POCD among patients 55 years or older undergoing major gynecologic oncology surgery.

Methods

This mixed-methods, prospective, observational cohort study followed patients 55 years or older who underwent surgery for gynecologic malignancies between February and July 2022. Semi-structured interviews and the Mini-Mental State Exam (MMSE) were administered before surgery as well as 1 and 3 months after. Assessments were delivered virtually and in-person in the context of the COVID-19 pandemic. POCD was defined as ≥2-point decline from baseline MMSE score.

Results

Twenty-four patients participated; 19 completed the 1-month follow-up, and 15 completed the 3-month follow-up. The average age was 64 (range: 56–90). The mean preoperative MMSE score was 16.6 out of 17 (virtual) and 12.9 out of 13 (in-person). Two patients had a 1-point decline in their 1-month MMSE score; both recovered by 3 months. One patient had a 1-point decline in their 3-month MMSE score. Semi-structured interviews revealed common themes of “brain fog” at the 1-month follow-up and mild, persistent attention and word-finding deficits at 3 months postoperatively.

Conclusions

This study’s qualitative component captured subtle subjective findings suggestive of potential POCD. Larger studies are required, and a more extensive neuropsychological test battery may be required to elicit subtle findings not clearly reflected by MMSE scores.

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来源期刊
CiteScore
3.30
自引率
5.60%
发文量
302
审稿时长
32 days
期刊介绍: Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.
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