在患有认知障碍的患者中,术后最佳实践和痴呆症
Danielle Scharp1, Kerry Meyers2, Girish Nadkarni2
1Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA network open
|March 12, 2026
概括
患有认知障碍的患者面临高的术后妄想风险. 目前的外科手术前最佳实践不足,需要为这个脆弱群体制定量身定制的战略.
科学领域:
- 麻醉学和外科手术期间的医学.
- 老年医学 老年医学
- 神经科学与认知健康
背景情况:
- 患有认知障碍的患者患上术后妄想症 (POD) 的风险明显更高.
- 现有的术后护理的进步还没有足够地减轻这种风险.
- 了解术后最佳实践与POD预防之间的联系对于高风险患者群体至关重要.
研究的目的:
- 调查遵守麻醉相关的最佳实践与术后妄想发病率之间的关联.
- 确定特定的外科手术期间的干预措施,可以降低患有先前认知障碍的患者的妄想风险.
主要方法:
- 观察性队列研究,对随机临床试验的探索性分析.
- 包括1255名患有手术前认知障碍的成年外科患者.
- 通过4A测试,评估了五个领域 (避开药物,血糖控制,血液动力学,正常热量,麻醉监测) 和术后痴呆症的12个术后最佳实践.
主要成果:
- 33.9%的患者出现了术后狂妄症.
- 个别的最佳实践,如保持葡萄糖<200 mg/dL,使用温度探针,保持温度>36°C,在不变的分析中与减少妄想的几率有关.
- 在多变量分析中,除了术后血糖监测外,没有任何单一的做法仍然具有意义,这与妄的可能性增加有关.
结论:
- 目前的术后策略虽然基于推,但不足以预防认知障碍患者的POD.
- 高的POD率强调了对精细的外科手术期间护理途径和对认知脆弱人群的新策略的需求.
- 为管理高风险患者,建议采用整合电子健康记录数据和麻醉工作流技术的定制干预措施.
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