谵妄与认知资料.ppt

术后谵妄与认知功能 脚踏实地，一步一个脚印，才能不断进步，走得更远！ ABSTRACT--BACKGROUND ABSTRACT--METHODS We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day 2, and at 1, 6, and 12 months after surgery Cognitive function was assessed with the use of the Mini Mental State Examination (MMSE). Delirium was diagnosed with the use of the Confusion Assessment Method ABSTRACT--RESULTS The 103 participants (46%) in whom delirium developed postoperatively had lower preoperative mean MMSE scores than those in whom delirium did not develop (25.8 vs26.9, P0.001) In adjusted models, those with delirium had a larger drop in cognitive function (as measured by the MMSE score) 2 days after surgery than did those without delirium (7.7 points vs. 2.1, P0.001) and had significantly lower postoperative cognitive function than those without delirium, both at 1 month (mean MMSE score, 24.1 vs. 27.4; P0.001) and at 1 year (25.2 vs. 27.2, P0.001) after surgery ABSTRACT--RESULTS With adjustment for baseline differences, the between-group difference in mean MMSE scores was significant 30 days after surgery (P0.001) but not at 6 or 12 months (P = 0.056 for both) A higher percentage of patients with delirium than those without delirium had not returned to their preoperative baseline level at 6 months (40%vs24%, P = 0.01), but the difference was not significant at 12 months (31% vs20%,P = 0.055) ABSTRACT--CONCLUSIONS Delirium is associated with a significant decline in cognitive ability during the first year after cardiac surgery, with a trajectory characterized by an initial decline and prolonged impairment (Funded by the Harvard Older Americans Independence Center and others.) Background 心脏手术后，认知障碍很常见，干预措施经常是无用的，而且许多患者不可能恢复到他们的术前水平 高龄、低教育水平,一个或多个危险因素的存在是术后认知能力降低的原因,但潜在可逆的的危险因素很少被确定 谵妄,即一种急性精神错乱状态,是一个潜在的可预防的危险因素,在心脏外科手术后大约有四分之三的病人都可能受到它