摘要
目的筛查择期手术老年患者术前认知障碍患病情况,并分析其影响因素,为围手术期风险管理提供依据。方法采用便利抽样法,筛查2023年7月至2024年6月在重庆某三甲医院外科行择期手术的老年患者的认知功能。调查工具包括自制一般人口学资料调查表、简易智能状态检查量表(Mini-mental State Examination,MMSE)等8个量表。收集的主要指标包括认知功能、自理能力、衰弱、营养、吞咽、焦虑抑郁、疼痛等评分;次要指标包括基本人口特征、社会支持、共病、用药等。采用多分类有序logistic回归进行数据分析。结果共筛查567例择期手术老年患者,平均年龄(71.81±6.34)岁,认知障碍总患病率为48.85%,其中,轻度认知障碍184例(32.45%),中、重度认知障碍93例(16.40%)。多分类有序Logistic回归分析显示,年龄较大、衰弱、抑郁是择期手术老年患者认知障碍发生的独立相关因素(P<0.05,OR>1);自理能力、营养状态、受教育时长与认知障碍严重程度呈独立负相关(P<0.05,OR<1)。结论择期手术老年患者术前认知障碍患病率较高,且与多因素相关,建议将其纳入围手术期医疗护理策略,进行早期干预。
Objective To screen the prevalence of preoperative cognitive impairment in elderly patients scheduled for elective surgery and to analyze its influencing factors,so as to provide a basis for enhancing perioperative risk management.Methods A cross-sectional survey was conducted using convenience sampling.Elderly patients awaiting elective surgery between July 2023 and June 2024 at a tertiary hospital in Chongqing were enrolled.Data were collected using a self-designed general information questionnaire,the Mini-Mental State Examination(MMSE),and eight other standardized scales.Primary assessment indicators included cognitive function,activities of daily living(Barthel Index),frailty,nutritional status,swallowing function,anxiety,depression,and pain.Secondary indicators encompassed basic demographics,social support,comorbidities,and medication use.Data were analyzed using multivariate ordinal logistic regression.Results A total of 567 elderly patients were included,with a mean age of(71.81±6.34)years.The overall prevalence of preoperative cognitive impairment was 48.85%,comprising 184 cases(32.45%)of mild cognitive impairment and 93 cases(16.40%)of moderate to severe impairment.Multivariate ordinal logistic regression analysis identified that older age,frailty,and depression were independent risk factors positively associated with the severity of cognitive impairment(P<0.05,OR>1).Conversely,self-care ability,nutritional status,and duration of education were independent protective factors,negatively associated with impairment severity(P<0.05,OR<1).Conclusion Preoperative cognitive impairment is highly prevalent and multifactorial among elderly elective surgery patients.It is recommended to integrate routine cognitive screening into perioperative management protocols to facilitate early identification and intervention.
作者
钟静知
陈文萍
冯艳
杨思琦
丁福
ZHONG Jingzhi;CHEN Wenping;FENG Yan;YANG Siqi;DING Fu(Department of Geriatrics,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016;School of Nursing,Chongqing Medical University,Chongqing 400016;Nursing Department,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中国老年保健医学》
2025年第6期51-56,共6页
Chinese Journal of Geriatric Care
关键词
认知障碍
择期手术
老年患者
衰弱
BARTHEL指数
抑郁
营养
cognitive dysfunction
elective surgical procedures
elderly patients
frailty
depression
nutritional status
perioperative period
risk factors
