López JMA, Vázquez EF, Aguilar MG, Cooper BD, Juárez PC

Idioma: Español
Referencias bibliográficas: 50
Paginas: 78-87
Archivo PDF: 83.32 Kb.

RESUMEN

El delirium, se caracteriza por alteraciones de las funciones cognoscitivas, de inicio agudo y curso fluctuante, de etiología compleja y a menudo multifactorial, ocurre en el 5-15% de los pacientes después una cirugía no cardiaca. Se sugiere que la disminución de las funciones ejecutivas, puede predecir delirium postquirúrgico en ausencia de deterioro cognitivo. El objetivo del estudio fue estimar la prevalencia de delirium postquirúrgico en pacientes mayores de 60 años del Hospital de Especialidades CMN Siglo XXI, y su relación con el desempeño en pruebas de funcionamiento ejecutivo previas a intervención quirúrgica no cardiaca.
Este es un un estudio transversal en pacientes entre 60 y 85 años, programados para cirugía de las diversas especialidades. Se les aplicó: Prueba de retención de dígitos inverso, Fluidez verbal, Fluidez fonológica, Stroop tiempo interferencia y Stroop aciertos interferencia (NEUROPSI) y Trail Making Test A y B para valorar funciones ejecutivas. Para el diagnóstico de delirium se utilizó el Confusion Assessment Method (CAM) y para determinar su gravedad el Delirium Rating Scale-Revised-98 (DRS-R-98). Se realizó chi cuadrada y t de student con STATA 11.
Se estudió a 64 pacientes mayores de 60 años, edad promedio 67.68 (7.67). La prevalencia de delirium fue de 10.94% (7); y el servicio de Angiología presento el mayor porcentaje con 42.86%(3). El 57.14%(4) desarrollo delirium subclínico y el 42.85% (3) desarrollo delirium grave. Se observaron diferencias significativas en la prueba de memoria de trabajo con un rendimiento leve a moderado en pacientes con delirium (28.57%) vs no delirium (5.26%) (p=0.05); rendimiento leve a moderado mayor en Prueba Stroop en pacientes con delirium (85.71% vs 35.09%) (p=0.05); promedio menor de palabras en fluidez verbal para pacientes con delirium [14.28 (5.85)] vs no delirium [18.18 (4.66)], (p=0.025). Observamos una relación entre disfunción ejecutiva prequirurgica y desarrollo de delirium post quirúrgico, particularmente con memoria de trabajo, fluidez verbal y Stroop aciertos interferencia. Los pacientes que desarrollaron delirium obtuvieron un bajo rendimiento en las pruebas de funcionamiento ejecutivo y una disminución en la velocidad de procesamiento. Esto sugiere que, a pesar de estar funcionalmente normales tienen alteraciones cognitivas preexistentes, en función, en muchas ocasiones, de la reserva cognitiva.

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