老年外科患者术前认知障碍的患病率：一项系统回顾和Meta分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：潘志军 编辑：张中伟 审校：曹莹
患有认知障碍的老年外科患者围手术期不良结果的风险增加，但在这一人群中，术前认知障碍的患病率尚不确定。本综述的目的是确定老年外科患者术前合并认知障碍的患病率。
我们纳入了MEDLINE (Ovid), PubMed (non MEDLINE records only), Embase, Cochrane Central, Cochrane系统评价数据库, PsycINFO和 EMCare Nursing从1946年至2021年4月中相关的文章。接受手术的患者年龄均≥60岁，并使用有效的认知评估工具进行术前认知障碍的评估。主要结果是接受择期（心脏或非心脏）或急诊手术的老年患者合并术前认知障碍的患病率。
共包括48项研究（n=42498）。在选择性非心脏手术中，27845名患者中未识别合并认知障碍的患病率为37.0%（95%可信区间[CI]：30.0%，45.0%），11676名患者中已诊断合并认知障碍的患病率为18.0%（95% CI：9.0%，33.0%）。在选择性非心脏手术类别中，对选择性骨科手术进行了分析。在这一亚类中，1117名患者中未识别合并认知障碍的患病率为37.0%（95% CI:26.0%，49.0%），6871名患者中已诊断合并认知障碍的患病率为17.0%（95% CI:3.0%，60.0%）。在心脏手术中，588名患者中未识别认知障碍的患病率为26.0%（95% CI:15.0%，42.0%）。在急诊手术中，2389名患者中未识别认知障碍的患病率为50.0%（95% CI:35.0%，65.0%）。
大量的外科病人有未被认识到的认知障碍。在选择性非心脏手术和急诊手术中，未识别合并认知障碍的患病率分别为37.0%和50.0%。术前认知筛查需要对风险评估和分层更多关注。
Paras Kapoor, Lina Chen ,Aparna Saripella,et al.Prevalence of preoperative cognitive impairment in older surgical patients.: A systematic review and meta-analysis [J]. (J Clin Anesth 2022 02;76 ).
Prevalence of preoperative cognitive impairment in older surgical patients.: A systematic review and meta-analysis
Abstract
Study objective: Older surgical patients with cognitive impairment are at an increased risk for adverse perioperative outcomes, however the prevalence of preoperative cognitive impairment is not well-established within this population. The purpose of this review is to determine the pooled prevalence of preoperative cognitive impairment in older surgical patients.
Design: Systematic review and meta-analysis.
Setting: MEDLINE (Ovid), PubMed (non-MEDLINE records only), Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsycINFO, and EMCare Nursing for relevant articles from 1946 to April 2021.
Patients: Patients aged ≥60 years old undergoing surgery, and preoperative cognitive impairment assessed by validated cognitive assessment tools.
Interventions: Preoperative assessment.
Measurements: Primary outcomes were the pooled prevalence of preoperative cognitive impairment in older patients undergoing either elective (cardiac or non-cardiac) or emergency surgery.
Main results: Forty-eight studies (n = 42,498) were included. In elective non-cardiac surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among 11,676 patients. Within the elective non-cardiac surgery category, elective orthopedic surgery was analyzed. In this subcategory, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%, 49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0% (95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the unrecognized cognitive impairment prevalence across 588 patients was 26.0% (95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389 patients.
Conclusions: A substantial number of surgical patients had unrecognized cognitive impairment. In elective non-cardiac and emergency surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants more attention for risk assessment and stratification.
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