术后妄想中的结构性脱节:在老年患者中进行的一项外科手术前两中心队列研究
Marinus Fislage1,2, Stefan Winzeck3,4, Rebecca Woodrow4,5
1Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
背景:
结构性失连接被发现先于痴呆出现。全脑白质异常也可能与术后谵妄(POD)相关。
方法:
我们招募了无痴呆症的老年患者(≥65岁),这些患者计划接受大型手术。在术前及术后3个月和12个月获取扩散峰度成像指标。我们计算了分数各向异性(FA)、平均扩散率(MD)、平均峰度(MK)和自由水(FW)。每日进行两次结构化且经过验证的谵妄评估。
结果:
在325例患者中,53例发生术后谵妄(POD)(16.3%)。发生POD的患者术前全局MD较高(标准化β值0.27[95%置信区间(CI)0.21–0.32],p < 0.001);术前全局MK(-0.07[95% CI -0.11至-0.04],p < 0.001)和FA(0.07[95% CI -0.10至-0.04],p < 0.001)较低。在校正基线扩散指标后,POD患者术后3个月MD降低(0.05[95% CI -0.08至-0.03],p < 0.001;n = 183),术后12个月MD升高(0.28[95% CI 0.20–0.35],p < 0.001;n = 45)。
Discussion:
术前结构连接断开与术后谵妄相关。术后谵妄可能导致术后3个月和12个月的白质减少。
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