停經對術後認知障礙的影響

Abstract

一、 研究目的 雖然在分子和動物的研究上女性荷爾蒙對認知功能有正向的影響，實際的臨床研究卻沒有定論。本研究針對女性在停經前與停經後的麻醉恢復與術後認知功能影響作前瞻性病例對照研究分析，以更進一步去探討賀爾蒙的變化對於女性在術後恢復與認知功能的改變。 二、 研究方法 目前麻醉後認知障礙並沒有統一的診斷標準，電腦化認知測驗在發展當中，我們引進台大職能治療所研發的平板電腦化認知測驗取代傳統測驗來評估術後認知障礙在臨床的應用。受試者為60位2016年在恩主公醫院接受常規手術採全身麻醉女性病人，年齡介於40到60歲，ASA:1~2，以中文溝通者。最後分析停經前30人，停經後28人。手術當天採用標準化麻醉流程，並且使用麻醉深度監測儀(BIS monitor, GE)維持麻醉深度。手術前後施測電腦化認知功能測驗，包括持續性注意力測驗和訊息處理速度測驗，去分析停經前與停經後的不同，並追蹤術後第七天，以確認賀爾蒙狀態是否會影響術後認知功能。研究結果以SPSS分析。 三、 研究結果 停經前(46.2±4.0)與停經後(52.7±3.4) 的兩組在基本變項除了平均年齡之外並沒有顯著的差異(p<0.001)，兩組在臨床恢復期的結果也沒有顯著的差異。將三個時間點的認知測驗分數(訊息處理速度和持續性注意力)用廣義評估方程來分析，並且將年齡因子控制後，停經前後並沒有顯著的差異，只有在重複地測量有顯著的差異。使用相關係數迴歸分析後，雖然所有的受試者術前的認知功能都受到年齡和教育程度的影響，在停經後的女性中停經時間對術前認知功能的相關性最強。 四、 結論 停經對於麻醉後的恢復和認知功能沒有影響，雖然所有的受試者術前的認知功能都受到年齡和教育程度的影響，在停經後的女性中停經時間對術前認知功能的相關性最強。

Background: Postoperative cognitive dysfunction (POCD) is a common complication after surgery. However, it remains unknown whether it is related to menopause status. Objective: To determine the effect of menopause status on the occurrence of POCD in women undergoing surgery with general anesthesia. Design: Cross-sectional, observational. Setting: Community hospital. Patients: Women 40-60 years of age undergoing elective general surgery expected to last less than 4 hours. Main outcome measures: Tablet-based Symbol Digit Modalities Test (T-SDMT) and Computerized-Digit Vigilance Test (C-DVT) results. The former measures information processing speed, and the later sustained attention. Tests were given prior to surgery, and on postoperative day (POD) 1 and 7. Results: Thirty pre- and 28 post-menopausal patients were included. The age of pre- and post-menopausal patients was significantly different (46.2±4.0 vs. 52.7±3.4 years, P < 0.001), while other characteristics were similar (all, P > 0.05). Post-menopausal patients had a significantly higher T-SDMT reaction time that pre-menopausal patients preoperatively (2.14±0.57 vs. 1.88±0.32, P = 0.039) and on POD 7 (1.99±0.47 vs. 1.7±0.23, P = 0.006). Post-menopausal patients had a significantly higher C-DVT hit-reaction time than pre-menopausal patients on POD 1 (2.12±0.31 vs. 1.99±0.2, P = 0.045) and POD 7 (2.07±0.3 vs. 1.94±0.14, P = 0.038). Adjusting for age and education, results of both tests were associated with measurement time, not menopause status. On POD 1, 43.3% of pre-menopausal and 46.4 % post-menopausal patients had a worse T-SDMT hit-reaction time than at baseline; at POD 7 the values were 0% and 10.7%, respectively. Pearson’s correlation analysis showed that at baseline prior to surgery, age and number of years post-menopause were significantly correlated with T-SDMT, and C-DVT was more strongly correlated with duration of menopause than age. Conclusions: By POD 7, menopause status has no effect on cognitive function in middle-aged women undergoing general surgery. Although menopause status did not affect POCD, baseline cognition, compared to age, was more affected by the duration of menopause.