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研究分析大手术入院与认知轨迹的相关性
来源:小柯机器人 发布时间:2019/8/12 16:33:27

威斯康星大学Robert D Sanders研究团队在研究中取得进展。他们分析了大手术入院与认知轨迹的相关性:白厅II队列研究的19年随访。 2019年8月10日出版的《英国医学杂志》发表了这项成果。

7532名成年参与者在1997年至2016年间接受了多达5次认知评估,由医院进行统计分析。暴露因素包括任何重大疾病住院,定义为在随访期间至少曾住院一晚。通过一系列认知测试,包括推理、记忆、音位和语义流利性,得出整体认知得分。采用贝叶斯线性混合模型分析参与者入院后年限相关认知轨迹的变化。此外,还计算了手术导致认知能力显著下降的几率。

大手术与小而长期的平均认知轨迹变化有关,该变化不如重大疾病入院大。术后认知能力大幅下降的几率约为术前的两倍,低于疾病入院的患者。在知情同意期间,应将这些信息与手术的潜在健康效益权衡利弊。

据了解,由于相当大的个人和社会负担,认知能力下降和痴呆是老年人主要的保健问题。认知衰退在65岁之前开始发生,并随着年龄的增长和并发症的积累而加速。某些健康事件,如中风,可导致认知轨迹的深刻变化,使认知能力发生永久性的“台阶式下降”。

附:英文原文

Title: Association between major surgical admissions and the cognitive trajectory: 19 year follow-up of Whitehall II cohort study

Author: Bryan M Krause, Séverine Sabia, Helen J Manning, Archana Singh-Manoux, Robert D Sanders

Issue&Volume: vol 366, issue 8210

Abstract: 

Objective To quantify the association between major surgery and the age related cognitive trajectory.

Design Prospective longitudinal cohort study.

Setting United Kingdom.

Participants 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up.

Main outcomes measures The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated.

Results After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0).

Conclusions Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery.

DOI: https://doi.org/10.1136/bmj.l4466

Source: https://www.bmj.com/content/366/bmj.l4466

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj


本期文章:《英国医学杂志》:Vol 366 Issue 8210