术后认知功能障碍不同诊断标准的合理性探讨

目的:探讨目前国内外常用的三种术后认知功能障碍(Postoperative Cognitive Dysfunction,POCD)诊断标准的合理性。方法:以100名中青年健康志愿者为研究对象,采用神经心理学测验测定认知功能三次,第一次测定(T0)作为基础值,第二次测定1(T1)和第三次测定(T2)分别与第一次测定间隔3d和30d。分别按照自身对比法、标准差法和Z计分法检测健康人群中T1和T2时认知功能变化程度超出正常范围的人数。以检测结果服从正态分布为判断标准。结果:完成全程测量者80人。按照三种POCD诊断标准诊断,在T1时,认知功能提高人数分别是认知功能降低人数的30倍、17倍和1倍,在T2时分别是32倍、26倍和1.5倍。结论:在采用神经心理学方法研究POCD时,用Z计分法诊断POCD比自身对比法和标准差法更能准确地反映认知功能的客观变化。

Research on the Rationality of Diagnosis Criterions of Postoperative Cognitive Dysfunction

Objective:To investigate the rationality of three diagnosis criterions on postoperative cognitive dysfunction (POCD) used in clinical study of POCD.Methods:After Research Ethics Board approval and informed consent, 100 young and middle-age healthy volunteers were recruited. We then measured and analyzed their cognitive function change with a battery of six neuropsychological tests on three occasions: first time (T0, baseline) and 3 day (T1), 30 day (T2) after the first time. The cases of cognitive improvement and cognitive dysfunction on T1 and T2 with three ways, self comparison, standard deviation and Z score were detected to assess the rationality of those. The criterion of rationality is that the detecting results follow the normal distribution.Results:80 objects had finished all the tests. The ratio of cognitive improvement and cognitive dysfunction according to the three ways were 30, 17, 1 at T1 and 32, 26, 1.5 at T2, respectively.Conclusion:Z score may be more accurate to reflect the objective change of cognitive function than self comparison and standard deviation when neuropsychological tests are administered in clinical study of POCD.