CAJ | 학술논문

目的比较"基本认知能力测验"软件(2.0版)与由国际术后认知功能障碍研究协作组(International study of postoperative cognitive dysfunction,ISPOCD)推荐的测验方法对老年人术后认知功能障碍(postoperative cognitive dysfunction,POCD)的评估效果,并研究两种方法分测验之间的相关性.方法由同一专人采用两种方法分别于术前1 d、术后7 d、术后3个月对131例60岁～80岁,择期行非心脏手术的老年人进行认知功能的评估.同时设立对照组,30例未行手术的健康老年人,于相同时间间隔完成上述两套测验."基本认知能力测验"(方法A)包括数字拷贝(A1),心算(A3)等,ISPOCD推荐的测验组合(方法B)包括连线测验(B1),符号数字模式测验(B2)等.两套测验的原始数据均采用Z计分法,Z≥2时判断患者发生了POCD.结果 ①131例人选患者中,120例完成术后7 d测验,67例完成术后3个月测验.②术后7 d POCD检出率,方法A和方法B无统计学差异(分别为12.5%与10.8%,P0.05);术后3个月POCD检出率亦无统计学差异(分别为5.97%与7.46%,P0.05).③两种方法在术后7 d和术后3个月对POCD的评估效果是一致的,Kappa为0.758与0.881,P<0.05.④术后7 d和术后3个月两种方法的组合"Z"计分之间均呈显著正相关(r为0.316与0.302,P<0.05).⑤在认知速度方面,数字拷贝(A1)与连线测验(BI)有显著相关性(r为0.517,P<0.05).在学习及工作能力方面,心算效率(A3)与符号数字模式测验(B2)有显著相关性(r为0.52,P<0.05).结论 "基本认知能力测验"与ISPOCD推荐的测验方法对老年人POCD的评估效果相同."基本认知能力测验"软件实用性强,在国人POCD评估方面具有临床应用价值.
목적 비교"기본인지능력측험"연건(2.0판)여유국제술후인지공능장애연구협작조(International study of postoperative cognitive dysfunction,ISPOCD)추천적측험방법대노년인술후인지공능장애(postoperative cognitive dysfunction,POCD)적평고효과,병연구량충방법분측험지간적상관성.방법 유동일전인채용량충방법분별우술전1 d、술후7 d、술후3개월대131례60세～80세,택기행비심장수술적노년인진행인지공능적평고.동시설립대조조,30례미행수술적건강노년인,우상동시간간격완성상술량투측험."기본인지능력측험"(방법A)포괄수자고패(A1),심산(A3)등,ISPOCD추천적측험조합(방법B)포괄련선측험(B1),부호수자모식측험(B2)등.량투측험적원시수거균채용Z계분법,Z≥2시판단환자발생료POCD.결과 ①131례인선환자중,120례완성술후7 d측험,67례완성술후3개월측험.②술후7 d POCD검출솔,방법A화방법B무통계학차이(분별위12.5%여10.8%,P0.05);술후3개월POCD검출솔역무통계학차이(분별위5.97%여7.46%,P0.05).③량충방법재술후7 d화술후3개월대POCD적평고효과시일치적,Kappa위0.758여0.881,P<0.05.④술후7 d화술후3개월량충방법적조합"Z"계분지간균정현저정상관(r위0.316여0.302,P<0.05).⑤재인지속도방면,수자고패(A1)여련선측험(BI)유현저상관성(r위0.517,P<0.05).재학습급공작능력방면,심산효솔(A3)여부호수자모식측험(B2)유현저상관성(r위0.52,P<0.05).결론 "기본인지능력측험"여ISPOCD추천적측험방법대노년인POCD적평고효과상동."기본인지능력측험"연건실용성강,재국인POCD평고방면구유림상응용개치.
Objective To compare basic cognitive capability teat (version 2.0) with the method recommended by ISPOCD (international study of postoperative cognitive dysfunction) on the evaluation of postoperative cognitive dysfunction (POCD) in elderly patients, and study the correlation of two different methods. Methods Two neuropsychological tests were performed preoperatively, and postoperatively on Day 7 and 3 months upon 131 elderly patients undergoing elective major non-cardiac surgery and 30 healthy elderly volunteers that were set as a control group. One was Basic Cognitive Capability Test (Method A), including digit copying (A1), mental arithmetic (A3), et al. However, The other was recommended by ISPOCD (Method B), including trail making test (B1), digit symbol sub-test (B2), et al. Z score was used to analyze the data. POCD was defined as Z score ≥2. Results (1) 120 out of 131 patients had completed the tests on Day 7 postoperatively, and then 67 among them had finished the tests 3 months postoperatively. (2) The incidence rate of POCD on Day 7 was (12.5% and 10.8%,P>0.05); and at 3 months was (5.97% and 7.46%, P >0.05). (3) Two methods were consistent for evaluation of POCD on Day 7 and 3 months postoperatively. Kappa were 0. 758 and 0.881, P<0.05. (4) Both on Day 7 and 3 months, the combined Z score of Method A and Method B had significant correlation, r =0.316 and 0.302 ,P < 0.05. (5) As for speed of recognition, digit copying (A1) vs. trail making test (B1) had significant correlation, r=0.517, P<0.05. For ability of study and performance, mental arithmetic (A3) vs. digit symbol subtest (B2) had significant correlation, r = 0. 52, P < 0. 05. Conclusion Basic cognitive capability test was consistent with tests recommended by ISPOCD for evaluation of POCD. Basic cognitive capability test using computer was more objective, accurate and beneficial for clinical practice.