老年腹部大手术患者术前腔隙性梗死与术后谵妄的关系：一项前瞻性队列研究。

IF 3.4 3区医学 Q2 GERIATRICS & GERONTOLOGY

Aging Clinical and Experimental Research Pub Date : 2025-01-29 DOI:10.1007/s40520-024-02909-1

Danni Li, Pan Gu, Yuhao Wang, Yuchen Yao, Dan Fan

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引用次数: 0

摘要

目的：研究择期腹部大手术老年患者术前腔隙性梗死（LACI）是否与术后谵妄（POD）相关。设计：前瞻性队列研究。环境和参与者：年龄≥65岁的中国三级甲等医院患者。方法：术后3天内采用混淆评定法对POD进行每日1次的评定。采用简易精神状态检查（MMSE）和北京版蒙特利尔认知评估量表在术前3天和术后4-7天内进行神经认知测试。在手术室记录局部脑氧饱和度（rScO2）。采用Logistic回归分析评价术前LACI对POD的影响，探讨POD的危险因素。结果：共分析369例受试者，术前laci阳性组（P组）161例，术前laci阴性组（N组）208例。本研究中POD的发生率为32.7%。P组POD发生率明显高于N组(39.1 vs 27.9%，危险比1.66；95% ci 1.07-2.58；p = 0.022)。此外，P组在手术过程中表现出较低的平均rScO2值(P结论和意义：术前LACI是常见的，是老年腹部手术患者发生POD的危险因素。尽管经常出现亚临床性质，术前LACI导致手术期间平均rScO2较低。这些发现有助于早期识别高风险POD患者。

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The association between preoperative lacunar infarcts and postoperative delirium in elderly patients undergoing major abdominal surgery: a prospective cohort study

Objective

The primary goal was to investigate whether the presence of preoperative lacunar infarcts (LACI) was associated with postoperative delirium (POD) in elderly patients undergoing elective major abdominal surgery.

Design

A prospective cohort study.

Setting and participants

Patients aged ≥ 65 years from a tertiary level A hospital in China.

Methods

The POD was assessed once daily within the first postoperative 3 days using the Confusion Assessment Method. Neurocognitive tests using the Mini-mental State Examination (MMSE) and the Beijing version of the Montreal Cognitive Assessment scales were carried out within 3 days before surgery and 4–7 days after surgery. Regional cerebral oxygen saturation (rScO₂) was recorded in the operating room. Logistic regression analysis was used to evaluate the impact of preoperative LACI on POD and to explore the risk factors for POD.

Results

A total of 369 participants were analyzed, 161 in the preoperative LACI-positive group (P group), and 208 in the preoperative LACI-negative group (N group), respectively. The incidence of POD was 32.7% in our study. The incidence of POD was significantly higher in the P group than in the N group (39.1 vs 27.9%, risk ratio, 1.66; 95% CI 1.07–2.58; P = 0.022). Furthermore, the P group exhibited lower mean rScO₂ values during the procedure (P < 0.001). In exploratory analysis, the advanced age (P = 0.005), sex (P = 0.038), and lower preoperative MMSE score (P = 0.019) were independent risk factors for POD in patients undergoing major abdominal surgery.

Conclusions and implications

Preoperative LACI was common, and constituted a risk factor for POD in older patients undergoing abdominal surgery. Despite the frequent subclinical nature, the preoperative LACI led to lower mean rScO₂ during the procedure. These findings could help early identification of high-risk POD patients.

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来源期刊

Aging Clinical and Experimental Research 医学-老年医学

CiteScore

7.90

自引率

5.00%

发文量

283

审稿时长

1 months

期刊介绍： Aging clinical and experimental research offers a multidisciplinary forum on the progressing field of gerontology and geriatrics. The areas covered by the journal include: biogerontology, neurosciences, epidemiology, clinical gerontology and geriatric assessment, social, economical and behavioral gerontology. “Aging clinical and experimental research” appears bimonthly and publishes review articles, original papers and case reports.