高血压脑出血患者术后发生谵妄的危险因素及预后的调查研究
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摘要
目的探讨高血压患者脑出血术后出现谵妄的危险因素及预后情况。方法选取2017年5月～2018年8月在我院收治的术后130例高血压脑出血患者作为研究对象,采用自行设计的调查问卷分析高血压脑出血术后谵妄发生情况、危险因素及预后情况。结果共130例患者,有37例出现术后谵妄,谵妄发病率为28.46%。单因素分析结果提示,发生谵妄和未发生谵妄高血压脑出血术后患者的年龄、出血量、手术时间、术后格拉斯哥昏迷指数评分(GCS)、机械通气以及术后低氧血症等6个因素比较,差异有统计学意义(P<0.05)。多因素Logistic分析结果提示,年龄(β=-0.854,OR=2.342,P<0.05)、出血量(β=-0.752,OR=1.756,P<0.05)、手术时间(β=-0.672,OR=1.526,P<0.05)、术后GCS评分(β=-0.558,OR=3.514,P<0.05)和术后低氧血症(β=-0.652,OR=4.514,P<0.05)是高血压脑出血患者术后发生谵妄的危险因素,而机械通气是其保护因素(β=0.614,OR=0.862,P<0.05)。高血压脑出血患者术后发生谵妄的90 d存活有21例,存活率为56.76%,明显低于未发生谵妄高血压脑出血术后患者的81例(87.10%),差异有统计学意义(P<0.05)。结论高血压脑出血术后谵妄发生受多种因素的影响,且与术后患者生存率密切相关。
Objective To investigate the risk factors and prognosis of postoperative delirium in patients with hypertensive intracerebralhemorrhage. Methods A total of 130 patients with hypertensive intracerebral hemorrhage who were treated in our hospital from May 2017 to August 2018 were selected as the research objects. The occurrence, risk factors and prognosis of delirium after hypertensive intracerebral hemorrhage were analyzed by self-designed questionnaire. Results A total of 130 patients, 37 patients showed postoperative delirium, the incidence of delirium was 28.46%. The results of univariate analysis indicated that there were statistically significant differences in age, blood loss, operation time, postoperative Glasgow coma index score(GCS), mechanical ventilation and postoperative hypoxemia between patients with and without delirium hypertensive cerebral hemorrhage(P<0.05). Multivariate Logistic analysis indicated that age(β=-0.854, OR=2.342, P<0.05), blood loss(β=-0.752, OR=1.756, P<0.05), operative time(β=-0.672, OR=1.526, P<0.05), postoperative GCS score(β=-0.558, OR=3.514, P<0.05) and postoperative hypoxemia(β=-0.652, OR=4.514, P<0.05) were risk factors for postoperative delirium in patients with hypertensive intracerebral hemorrhage. Mechanical ventilation was the protective factor for postoperative delirium in patients with hypertensive intracerebral hemorrhage(β=0.614, OR=0.862, P<0.05). Twenty-one patients survived 90 days after surgery for delirium hypertensive intracerebral hemorrhage, the survival rate was 56.76%, which was significantly lower than that of 81 patients without postoperative delirium hypertensive cerebral hemorrhage(87.10%), and the difference was statistically significant(P<0.05). Conclusion The occurrence of delirium after hypertensive intracerebral hemorrhage is influenced by many factors and is closely related to the survival rate of patients after operation.
Objective To investigate the risk factors and prognosis of postoperative delirium in patients with hypertensive intracerebralhemorrhage. Methods A total of 130 patients with hypertensive intracerebral hemorrhage who were treated in our hospital from May 2017 to August 2018 were selected as the research objects. The occurrence, risk factors and prognosis of delirium after hypertensive intracerebral hemorrhage were analyzed by self-designed questionnaire. Results A total of 130 patients, 37 patients showed postoperative delirium, the incidence of delirium was 28.46%. The results of univariate analysis indicated that there were statistically significant differences in age, blood loss, operation time, postoperative Glasgow coma index score(GCS), mechanical ventilation and postoperative hypoxemia between patients with and without delirium hypertensive cerebral hemorrhage(P<0.05). Multivariate Logistic analysis indicated that age(β=-0.854, OR=2.342, P<0.05), blood loss(β=-0.752, OR=1.756, P<0.05), operative time(β=-0.672, OR=1.526, P<0.05), postoperative GCS score(β=-0.558, OR=3.514, P<0.05) and postoperative hypoxemia(β=-0.652, OR=4.514, P<0.05) were risk factors for postoperative delirium in patients with hypertensive intracerebral hemorrhage. Mechanical ventilation was the protective factor for postoperative delirium in patients with hypertensive intracerebral hemorrhage(β=0.614, OR=0.862, P<0.05). Twenty-one patients survived 90 days after surgery for delirium hypertensive intracerebral hemorrhage, the survival rate was 56.76%, which was significantly lower than that of 81 patients without postoperative delirium hypertensive cerebral hemorrhage(87.10%), and the difference was statistically significant(P<0.05). Conclusion The occurrence of delirium after hypertensive intracerebral hemorrhage is influenced by many factors and is closely related to the survival rate of patients after operation.
引文
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[11]王彬,张其亮,李军,等.老年患者髋关节置换术后谵妄和认知功能障碍的危险因素[J].临床麻醉学杂志,2013,29(8):785-788.
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[15]邵兆军.术后谵妄发生机制的研究进展[J].继续医学教育,2017,31(5):93-95.
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[19]李国威.老年髋关节置换术后谵妄的进展研究[J].贵州医药,2017,41(2):212-213.
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[21]李文燕,姜敏.妇科腹腔镜全麻术后谵妄危险因素的分析[J].中国医药指南,2013,11(36):390-391.
[22]王辉,秦再生,徐建设,等.二氧化碳气腹及头低位对老年患者脑氧供需平衡和能量代谢的影响[J].新乡医学院学报,2011;28(6):746-748.
[23]李泓邑.高血压患者行腹部手术时脑氧饱和度下降对其术后认知功能的影响[D].武汉:华中科技大学同济医学院附属同济医院麻醉学教研室,2015.
[24]Lei C,Wu B,Liu M,et al.Differences between vascular structural abnormality and hypertensive intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2015,24(8):1811-1816.
[25]KlimiecE,Dziedzic T,Kowalska K,et al.Knowns and unknowns about deliriumin stroke:a review[J].Cogn Behav Neurol,2016,29(4):174-189.
[26]吕学文,黄文,董蜀华.地塞米松对骨关节置换术老年患者术后谵妄及认知功能障碍的影响[J].中国医药导报,2017,14(27):140-143.
[27]解鑫隆,徐朝军,尹晓清,等.醒脑静辅助奥氮平治疗主动脉夹层腔内隔绝术后谵妄45例[J].西部中医药,2018,31(10):27.
[28]王倩,董慧领,张崇,等.超声引导下股神经置管对高龄单膝置换患者术后镇痛及谵妄的影响[J].中国医药导报,2018,15(31):113-116.
[2]刘金虎,岳云.老年非心脏手术患者术后澹妄危险因素分析[J].临床麻醉学杂志,2009,25(2):162-163.
[3]刘小兵,谭庆荣,王志忠,等.奥氮平与氟哌啶醇治疗谵妄的对照研究[J].华南国防医学杂志,2008,22(6):1-3.
[4]甘玉华.高血压脑出血术后急性期并发症的预见性护理效果观察[J].海南医学,2013,24(5):777-779.
[5]张承华,麻伟青,杨云丽,等.老龄患者术后谵妄的发生率及危险因素分析[J].昆明医学院学报,2010,31(11):137-139.
[6]Sieber FE,Zakriya KJ,Gottschalk A,et al.Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair[J].Mayo Clin Proc,2010,85(1):18-26.
[7]Yu SX,Zhang QS,Yin Y,et al.Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage[J].Eur Rev Med Pharmacol Sci,2016,20(22):4750-4755.
[8]Liu Z,Chen Q,Tian D,et al.Clinical significance of dynamic monitoring by transcranial Doppler ultrasound and intracranial pressure monitor after surgery of hypertensive in tracerebral hemorrhage[J].Int J Clin Exp Med,2015,8(7):11456-11 462.
[9]杨新平.高血压脑出血急性脑庙手术治疗效果分析[J].海南医学,2012,23(14):123-124.
[10]谭刚,郭向阳,罗爱伦,等.老年非心脏手术患者术后谵妄的流行病学调查[J].协和医学杂志,2011,2(4):319-325.
[11]王彬,张其亮,李军,等.老年患者髋关节置换术后谵妄和认知功能障碍的危险因素[J].临床麻醉学杂志,2013,29(8):785-788.
[12]穆雪侠,王建武,刘晓敏,等.75例术后瞻妄临床特征及危险因素分析[J].安徽医药,2012,16(10):1451-1453.
[13]李慧颖,陈琰,李学锋,等.术后谵妄病理生理机制的研究进展[J].中国老年学杂志,2013,33(22):5777-5778.
[14]周波,黎柏源,白万胜.高血压脑出血患者术后澹妄的相关因素分析[J].海南医学,2014,25(1):72-73.
[15]邵兆军.术后谵妄发生机制的研究进展[J].继续医学教育,2017,31(5):93-95.
[16]Chen G,Ping L,Zhou S,et al.Early prediction of death in acute hypertensive intracerebral hemorrhage[J].Exp Ther Med,2016,11(1):83-88.
[17]Ohki S,Ohshimo S,Shime N.Potential confounders of the accuracy and reliability of delirium assessment tools[J].Crit Care Med,2017,45(1):e114.
[18]杨亚青,奚曦,黄远林,等.不同术后镇痛方式对腹腔镜胆囊切除术患者术后谵妄的影响[J].昆明医科大学学报,2012,33(8):41-43.
[19]李国威.老年髋关节置换术后谵妄的进展研究[J].贵州医药,2017,41(2):212-213.
[20]张海涛,唐远志,秦颖.60岁以上结直肠癌患者术后谵妄的危险因素和临床结局[J].中华胃肠外科杂志,2017,20(11):1263-1268.
[21]李文燕,姜敏.妇科腹腔镜全麻术后谵妄危险因素的分析[J].中国医药指南,2013,11(36):390-391.
[22]王辉,秦再生,徐建设,等.二氧化碳气腹及头低位对老年患者脑氧供需平衡和能量代谢的影响[J].新乡医学院学报,2011;28(6):746-748.
[23]李泓邑.高血压患者行腹部手术时脑氧饱和度下降对其术后认知功能的影响[D].武汉:华中科技大学同济医学院附属同济医院麻醉学教研室,2015.
[24]Lei C,Wu B,Liu M,et al.Differences between vascular structural abnormality and hypertensive intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2015,24(8):1811-1816.
[25]KlimiecE,Dziedzic T,Kowalska K,et al.Knowns and unknowns about deliriumin stroke:a review[J].Cogn Behav Neurol,2016,29(4):174-189.
[26]吕学文,黄文,董蜀华.地塞米松对骨关节置换术老年患者术后谵妄及认知功能障碍的影响[J].中国医药导报,2017,14(27):140-143.
[27]解鑫隆,徐朝军,尹晓清,等.醒脑静辅助奥氮平治疗主动脉夹层腔内隔绝术后谵妄45例[J].西部中医药,2018,31(10):27.
[28]王倩,董慧领,张崇,等.超声引导下股神经置管对高龄单膝置换患者术后镇痛及谵妄的影响[J].中国医药导报,2018,15(31):113-116.