Abstract：
BACKGROUND: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery.
OBJECTIVE: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors.
METHODS: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery.
RESULTS: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors.
CONCLUSIONS: Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.
OBJECTIVE: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors.
METHODS: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery.
RESULTS: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors.
CONCLUSIONS: Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment.
摘要：
背景：老年患者更容易出现认知功能障碍，接受外科手术的患者中有很大一部分是老年人。术后认知功能障碍（POCD）已被证明是心脏手术等大型外科手术后的一致并发症。
目的：确定≥65岁的冠状动脉旁路移植术和主动脉瓣置换术患者是否存在长期POCD，并建立相关的风险因素。
方法：我们前瞻性和顺序地纳入了44例冠状动脉疾病和主动脉瓣狭窄患者，这些患者计划进行心脏手术。对所有患者进行标准化随访，并在术前和术后1、6和12个月进行神经认知评估。
结果：患者出现明显的术后认知功能障碍（33.5%，在1个月、6个月和12个月时分别为63.4%和38.9%，分别）从基线（20.5%）。患者相关方面，如年龄(p<0.01)，吸烟史（p<0.01），动脉高血压（p=0.022），糖尿病（p=0.024），心力衰竭（p=0.036）和术前认知功能障碍（p<0.01），与手术相关的方面，如EuroSCORE（p<0.01）和手术时间（p<0.01）被确定为相关危险因素。
结论：接受心脏手术的老年患者有长期POCD。患者和手术相关的危险因素均被确定为相关危险因素。这些发现表明，老年患者心脏手术后认知功能障碍的患病率可能与痴呆的可能进展有关。此外,确定的许多风险因素可能是可以修改的，但在实践中，这些患者因其可能的认知障碍而未接受治疗。
目的：确定≥65岁的冠状动脉旁路移植术和主动脉瓣置换术患者是否存在长期POCD，并建立相关的风险因素。
方法：我们前瞻性和顺序地纳入了44例冠状动脉疾病和主动脉瓣狭窄患者，这些患者计划进行心脏手术。对所有患者进行标准化随访，并在术前和术后1、6和12个月进行神经认知评估。
结果：患者出现明显的术后认知功能障碍（33.5%，在1个月、6个月和12个月时分别为63.4%和38.9%，分别）从基线（20.5%）。患者相关方面，如年龄(p<0.01)，吸烟史（p<0.01），动脉高血压（p=0.022），糖尿病（p=0.024），心力衰竭（p=0.036）和术前认知功能障碍（p<0.01），与手术相关的方面，如EuroSCORE（p<0.01）和手术时间（p<0.01）被确定为相关危险因素。
结论：接受心脏手术的老年患者有长期POCD。患者和手术相关的危险因素均被确定为相关危险因素。这些发现表明，老年患者心脏手术后认知功能障碍的患病率可能与痴呆的可能进展有关。此外,确定的许多风险因素可能是可以修改的，但在实践中，这些患者因其可能的认知障碍而未接受治疗。
