【原】【罂粟摘要】代谢综合征与发生术后谵妄和术后认知功能障碍风险的关联：一项多中心队列研究

代谢综合征与发生术后谵妄和术后认知功能障碍风险的关联：一项多中心队列研究

贵州医科大学    麻醉学与心脏电生理课题组

翻译：宋雨婷        编辑：宋雨婷         审校：曹莹

目的

代谢综合征及其组成部分是认知障碍的危险因素，但它们对围术期神经认知障碍的影响尚不清楚。本研究旨在探讨合并代谢综合征的老年患者与发生术后谵妄（POD）和术后认知功能障碍（POCD）风险的关联。

方法

本试验共纳入765名年龄≥65岁的受试对象。术前测量代谢参数，筛查术后7天或住院期间发生POD的患者。通过比较六项神经心理学测试与非手术对照组的认知变化来确定发生POCD。采用多元logistic回归分析代谢参数与发生POD和POCD风险的关联，根据年龄、性别和手术类型进行了调整。

结果

共有149名受试对象（765名受试对象中19.5%）发生POD，53名受试对象（参与为期3个月随访的520名受试者中10.1%）发生POCD。合并代谢综合征的受试对象发生POD的风险增高1.85倍（95%置信区间[CI] 1.26–2.70）。高密度脂蛋白胆固醇（HDL-C）每增加1mM，发生POD的风险降低0.47倍（95% CI 0.30–0.74）；体质指数（BMI）每增加1kg/m²，发生POCD的风险增加1.09倍（95%CI 1.02-1.16）。

结论

合并代谢综合征的老年手术患者发生POD的风险增加，降低的HDL-C与POD显著相关。术前较高的BMI被确定为POCD的危险因素。这些研究结果增加了发生POD和POCD的流行病学证据。术前应进行HDL-C、BMI以及代谢干预的风险评估以减少围术期神经认知障碍。

原始文献来源：

Feinkohl I, Janke J, Slooter AJC, et al. Metabolic syndrome and the risk of postoperative delirium and postoperative cognitive dysfunction: a multi-centre cohort study. Br J Anaesth. 2023;131(2):338-347.

英文原文

Metabolic syndrome and the risk of postoperative delirium and postoperative cognitive dysfunction: a multi-centre cohort study

Background: Metabolic syndrome and its components are risk factors for cognitive impairment, but their contribution to perioperative neurocognitive disorders is unknown. We examined their associations with the risk of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in older patients.

Methods: In 765 male and female participants aged ≥65 years, we measured preoperative metabolic parameters and screened for POD for 7 days or until discharge. POCD was defined through comparison of cognitive change on six neuropsychological tests with non-surgical controls. Multiple logistic regression analyses examined the association of metabolic parameters with risk of POD and POCD with adjustment for age, sex, and surgery type.

Results: A total of 149 patients (19.5% of 765) developed POD and 53 (10.1% of 520 attendees) had POCD at 3 months. Patients with metabolic syndrome were at 1.85-fold higher risk of POD (95% confidence interval [CI] 1.26–2.70). Each 1 mM higher high-density lipoprotein cholesterol (HDL-C) was associated with a 0.47-fold lower POD risk (95% CI 0.30–0.74). Each 1 kg m−2 higher body mass index (BMI) was associated with a 1.09-fold higher POCD risk (95% CI 1.02– 1.16).

Conclusions: Older surgical patients with metabolic syndrome were at increased risk of POD. Only reduced HDL-C was significantly associated with POD. For POCD, a higher preoperative BMI was identified as a risk factor. These findings add to mounting evidence of a distinct epidemiology of POD and POCD. Screening programmes taking advantage of HDL-C and BMI measurements and of metabolic interventions in reducing perioperative neurocognitive disorders should be evaluated.