邮件订阅 RSS 中文 | English
高级检索

术前轻度认知功能障碍对早期术后认知功能障碍的预测价值

Predictive value of preoperative mild cognitive impairment for early postoperative cognitive dysfunction

    摘要
  • 摘要:
    目的 评估非神经、非心脏手术术前存在轻度认知功能障碍（MCI）的患者早期术后认知功能障碍（POCD）的发病率，明确MCI对术后发生早期POCD的预测价值。
    方法 回顾性分析2018年9月至2021年6月在同济大学附属同济医院行非心脏及非神经外科手术的106例患者（>65岁）的病例资料。所有入组患者于手术前1 d和术后7 d进行神经心理学评估。排除4例简易智力状态检查量表（MMSE）评分 < 23分患者，将余研究对象随机分为建模组（n=87）和验证组（n=15）。根据MCI诊断标准，将建模组患者进一步分为MCI组和非MCI组，比较两亚组术后早期POCD的发病率。对POCD的危险因素进行logistic回归分析，构建发生早期POCD的预测模型。用验证组人群对预测模型进行外部验证，进而评估该预测模型的诊断价值。
    结果 建模人群中，MCI组28例（32.2%），发生早期POCD者6例（21.4%）；非MCI组59例（67.8%），发生早期POCD者16例（27.1%）。MCI组与非MCI组患者早期POCD的发生率差异无统计学意义。Logistic回归分析显示，数字符号替代测试（DSST）评分是该类患者发生早期POCD的独立危险因素（P=0.03）。建模组预测模型的曲线下面积（AUC）为0.883（95% CI 0.807~0.959），验证组预测模型的AUC为0.840（98% CI 0.583~1.000）；校准曲线提示该预测模型具有较好的稳定性。
    结论 对于接受非神经及非心脏手术的患者，术前存在MCI不影响早期POCD，但DSST评分降低时，应警惕POCD的发生。

     

    Abstract:
    Objective To evaluate the incidence rate of postoperative cognitive dysfunction (POCD) in patients with mild cognitive impairment (MCI) before operation and to evaluate the predictive value of MCI for early POCD.
    Methods The clinical data of 106 patients (>65 years old) undergoing non-cardiac and non-neurological operations in Tongji Hospital, Tongji University from September 2018 to June 2021 were retrospectively analyzed. All the included patients underwent neuropsychological evaluation at least one day before the operation and the seventh day after the operation. Four patients with mini-mental state examination (MMSE) score < 23 points were excluded. The other patients were randomly divided into the experimental group (n=87) and the verification group (n=15). The patients in the experimental group were divided into MCI group and non-MCI group according to the MCI diagnostic criteria, and the incidence rate of early POCD was compared betweent the two subgroups. The risk factors of early POCD were analyzed by the logistic regression analysis, and the prediction model of early POCD was constructed. The prediction model was externally corroborated in the verification group, and the diagnostic value of the model was evaluated.
    Results There were 28 patients with MCI (32.2%), among whom 6 patients with early POCD (21.4%); 59 patients with non-MCI (67.8%), and among whom16 patients with early POCD (27.1%). There was no statistical difference in the incidence of early POCD between the two subgroups. Logistic regression analysis showed that the score of the digital symbol substitution test (DSST) was an independent risk factor for the occurrence of early POCD (P=0.03). The AUC value of the prediction model in the experimental group was 0.883 (95% CI 0.807-0.959) and that in the control group was 0.840 (98% CI 0.583-1.000). The calibration curve results showed that the prediction model had good stability.
    Conclusion For patients undergoing non-neurological and non-cardiac operations, the MCI before operation does not affect the occurrence of POCD in the early stage after the operation. However, when the DSST score decreases, POCD should be alerted.

     

    • HTML全文
    • 参考文献(17)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回