disfunção cognitiva pós-operatória: prevalência e fatores associados disfunción cognoscitiva pos-operatoria: superioridad y factores asociados postoperative cognitive dysfunction: prevalence and associated factors
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2005
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Abstract
JUSTIFICATIVA E OBJETIVOS: A disfunção cognitiva pós-operatória (DCPO) está relacionada a fatores como o estado físico, distúrbios eletrolíticos, visuais e imunológicos, alcoolismo, fármacos e senilidade. Este estudo teve por objetivos determinar a prevalência de DCPO e seus fatores associados. MÉTODO: Foram estudados 55 pacientes, com idade entre 18 e 89 anos, submetidos a cirurgias eletivas ortopédicas, urológicas, digestivas ou vasculares, sob anestesia geral ou regional. Foi aplicado o Mini-Exame de Estado Mental (MEEM) na véspera da data da cirurgia (M0), 24 horas após (M1) e 3 a 7 dias após a cirurgia (M2). A DCPO foi caracterizada por escore do MEEM menor que 24/30 pontos ou diferença maior ou igual a 4 pontos em relação a M0. As variáveis utilizadas nas análises uni e multivariadas foram a idade, o sexo, o tipo de anestesia, o tipo de cirurgia, a ocorrência de hipotensão arterial, hipoxemia ou hipocapnia intra-operatórias, o uso de atropina e a duração da cirurgia. RESULTADOS: DCPO ocorreram em oito pacientes (14,54%). Todos os casos de DCPO ocorreram em pacientes com idade superior a 65 anos. Nesta faixa etária, a prevalência de DCPO foi de 28,57%. Somente a idade e os valores pré-anestésicos do MEEM diferiram entre os que apresentaram e os que não apresentaram DCPO. O modelo logístico incluiu somente o escore pré-anestésico do MEEM. CONCLUSÕES: Entre as variáveis incluídas neste estudo, somente o valor pré-anestésico do escore do MEEM pode ser considerado um fator de previsão independente da ocorrência de DCPO.
JUSTIFICATIVA Y OBJETIVOS: La disfunción cognoscitiva pos-operatoria (DCPO) está relacionada a factores como el estado físico, disturbios electrolíticos, visuales e inmunológicos, alcoholismo, fármacos y senilidad. Este estudio tuvo el objetivo de determinar la superioridad de DCPO y sus factores asociados. MÉTODO: Se estudiaron 55 pacientes, con edad entre 18 y 89 años, sometidos a cirugías electivas ortopédicas, urológicas, digestivas o vasculares, bajo anestesia general o regional. Fue aplicado el Mini-Examen del Estado Mental (MEEM) en la víspera de la fecha de la cirugía (M0), 24 horas después (M1) y 3 a 7 días después la cirugía (M2). La DCPO fue caracterizada por el resultado del MEEM menor que 24/30 puntos o diferencia mayor o igual a 4 puntos con relación al M0. Las variables utilizadas en los análisis uni y multivariadas fueron la edad, el sexo, el tipo de anestesia, el tipo de cirugía, la ocurrencia de hipotensión arterial, hipoxemia o hipocapnia intra-operatorias, el uso de atropina y la duración de la cirugía. RESULTADOS: DCPO ocurrieron en ocho pacientes (14,54%). Todos los casos de DCPO ocurrieron en pacientes con edad superior a 65 años. En esta banda etária, la superioridad de DCPO fue del 28,57%. Solamente la edad y los valores pre-anestésicos del MEEM difirieron entre los que presentaron y los que no presentaron DCPO. El modelo logístico incluyó solamente el resultado pre-anestésico del MEEM. CONCLUSIONES: Entre las variables incluidas en este estudio, solamente el valor pre-anestésico del resultado del MEEM puede ser considerado un factor de previsión independiente de la ocurrencia de DCPO.
BACKGROUND AND OBJECTIVES: Postoperative cognitive dysfunction (POCD) is related to factors such as physical status, electrolytic, visual and immune disorders, alcoholism, drugs and advanced age. This study aimed at determining the prevalence of POCD and its associated factors. METHODS: Participated in this prospective study 55 patients aged 18 to 89 years, scheduled for elective orthopedic, urologic, general or vascular surgeries, under general or regional anesthesia. The Mini-Mental State Examination (MMSE) was applied the day before surgery (M0), at 24 postoperative hours (M1) and 3 to 7 days after surgery (M2). POCD was defined as MMSE score below 24/30 or as a difference equal to or above 4 as compared to M0. Univariate and multivariate analysis variables included age, gender, type of anesthesia and surgery, intraoperative hypotension, hypoxemia or hypocapnia, use of atropine and surgery length. RESULTS: POCD was observed in eight patients (14.54%). All POCD patients were above 65 years of age. Among these patients, the prevalence of POCD was 28.57%. Only age and preanesthetic MMSE scores were different between patients with or without POCD. The logistic model included only preanesthetic MMSE scores. CONCLUSIONS: Among the variables included in this study, only preanesthetic MMSE score is a significant independent predictor of POCD.
JUSTIFICATIVA Y OBJETIVOS: La disfunción cognoscitiva pos-operatoria (DCPO) está relacionada a factores como el estado físico, disturbios electrolíticos, visuales e inmunológicos, alcoholismo, fármacos y senilidad. Este estudio tuvo el objetivo de determinar la superioridad de DCPO y sus factores asociados. MÉTODO: Se estudiaron 55 pacientes, con edad entre 18 y 89 años, sometidos a cirugías electivas ortopédicas, urológicas, digestivas o vasculares, bajo anestesia general o regional. Fue aplicado el Mini-Examen del Estado Mental (MEEM) en la víspera de la fecha de la cirugía (M0), 24 horas después (M1) y 3 a 7 días después la cirugía (M2). La DCPO fue caracterizada por el resultado del MEEM menor que 24/30 puntos o diferencia mayor o igual a 4 puntos con relación al M0. Las variables utilizadas en los análisis uni y multivariadas fueron la edad, el sexo, el tipo de anestesia, el tipo de cirugía, la ocurrencia de hipotensión arterial, hipoxemia o hipocapnia intra-operatorias, el uso de atropina y la duración de la cirugía. RESULTADOS: DCPO ocurrieron en ocho pacientes (14,54%). Todos los casos de DCPO ocurrieron en pacientes con edad superior a 65 años. En esta banda etária, la superioridad de DCPO fue del 28,57%. Solamente la edad y los valores pre-anestésicos del MEEM difirieron entre los que presentaron y los que no presentaron DCPO. El modelo logístico incluyó solamente el resultado pre-anestésico del MEEM. CONCLUSIONES: Entre las variables incluidas en este estudio, solamente el valor pre-anestésico del resultado del MEEM puede ser considerado un factor de previsión independiente de la ocurrencia de DCPO.
BACKGROUND AND OBJECTIVES: Postoperative cognitive dysfunction (POCD) is related to factors such as physical status, electrolytic, visual and immune disorders, alcoholism, drugs and advanced age. This study aimed at determining the prevalence of POCD and its associated factors. METHODS: Participated in this prospective study 55 patients aged 18 to 89 years, scheduled for elective orthopedic, urologic, general or vascular surgeries, under general or regional anesthesia. The Mini-Mental State Examination (MMSE) was applied the day before surgery (M0), at 24 postoperative hours (M1) and 3 to 7 days after surgery (M2). POCD was defined as MMSE score below 24/30 or as a difference equal to or above 4 as compared to M0. Univariate and multivariate analysis variables included age, gender, type of anesthesia and surgery, intraoperative hypotension, hypoxemia or hypocapnia, use of atropine and surgery length. RESULTS: POCD was observed in eight patients (14.54%). All POCD patients were above 65 years of age. Among these patients, the prevalence of POCD was 28.57%. Only age and preanesthetic MMSE scores were different between patients with or without POCD. The logistic model included only preanesthetic MMSE scores. CONCLUSIONS: Among the variables included in this study, only preanesthetic MMSE score is a significant independent predictor of POCD.
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boos2005revistadisfuno
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| Authors | ;Gustavo Luchi Boos;Luiz Fernando Soares;Getúlio Rodrigues de Oliveira Filho |
| Journal | methods in molecular biology (clifton, nj) |
| Year | 2005 |
| DOI |
10.1590/S0034-70942005000500006
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