老年患者脊柱术后谵妄的危险因素分析
|
摘要
目的探讨老年患者脊柱术后发生谵妄的相关危险因素。方法选取358例在静脉吸入复合麻醉下行脊柱手术患者(年龄≥60岁)的基本资料,根据术后是否发生谵妄将患者分为谵妄组与非谵妄组。对患者的年龄、性别、BMI、是否有基础疾病(高血压、糖尿病、冠心病)、手术部位、手术时间、术中出血量、术后发热情况、术后低氧血症及实验室检查结果等因素进行统计,分析各因素对老年患者脊柱术后谵妄发生的影响。结果37例发生术后谵妄,发生率为10. 3%。单因素分析结果显示,年龄、性别、手术时间、手术部位、术中出血量、术后是否发热及术后是否出现低氧血症两组间比较差异有统计学意义(P <0. 05);术后血红蛋白、红细胞比容两组间比较差异有统计学意义(P <0. 05)。多因素logistic回归分析显示,年龄、手术时间及术后发热、低氧血症是术后谵妄产生的独立危险因素。结论年龄、手术时间、术后发热、术后低氧血症是发生术后谵妄的独立危险因素,缩短手术时间、术后发热管理和避免低氧血症可能会减少术后谵妄的患病率。
Objective To investigate the risk factors for delirium of the elderly patients after spinal operation. Methods The basic data of 358 patients( aged over or equal to 60 years) undergoing spinal surgery in venous inhalation anesthesia were selected. According to postoperative delirium,the patients were divided into delirium group and nondelirium group. The following factors of patients' age,gender,body mass index( BMI),whether the merger underlying diseases( hypertension,diabetes,coronary heart disease),surgical site,the duration of operation,intraoperative blood loss,the postoperative fever status,hypoxemia and laboratory findings were carried on the risk assessment by means of statistical analysis,to predict the responsibility rate for elderly spine patients with postoperative delirium.Results Postoperative delirium developed in 37 patients,the incidence rate of postoperative delirium was 10. 3%.The single factor risk analysis showed that there were significant differences among delirium and non-delirium in age,gender,operation duration,operative site,intraoperative blood loss,postoperative fever and hypoxemia( P < 0. 05).Postoperative hemoglobin,hematocrit between patients with delirium and non-delirium group difference were statistically significant( P < 0. 05). While multiple factors logistic regression analysis indicated that age,operation duration,postoperative fever and postoperative hypoxemia were the risk factors of delirium status after spinal surgery. Conclusions Age,operative time,postoperative fever and postoperative hypoxemia are independent risk factors for postoperative patients undergoing spinal surgery. Shortening the operation time,management of postoperative fever and avoid hypoxemia may contribute to reduce the incidence of postoperative delirium.
Objective To investigate the risk factors for delirium of the elderly patients after spinal operation. Methods The basic data of 358 patients( aged over or equal to 60 years) undergoing spinal surgery in venous inhalation anesthesia were selected. According to postoperative delirium,the patients were divided into delirium group and nondelirium group. The following factors of patients' age,gender,body mass index( BMI),whether the merger underlying diseases( hypertension,diabetes,coronary heart disease),surgical site,the duration of operation,intraoperative blood loss,the postoperative fever status,hypoxemia and laboratory findings were carried on the risk assessment by means of statistical analysis,to predict the responsibility rate for elderly spine patients with postoperative delirium.Results Postoperative delirium developed in 37 patients,the incidence rate of postoperative delirium was 10. 3%.The single factor risk analysis showed that there were significant differences among delirium and non-delirium in age,gender,operation duration,operative site,intraoperative blood loss,postoperative fever and hypoxemia( P < 0. 05).Postoperative hemoglobin,hematocrit between patients with delirium and non-delirium group difference were statistically significant( P < 0. 05). While multiple factors logistic regression analysis indicated that age,operation duration,postoperative fever and postoperative hypoxemia were the risk factors of delirium status after spinal surgery. Conclusions Age,operative time,postoperative fever and postoperative hypoxemia are independent risk factors for postoperative patients undergoing spinal surgery. Shortening the operation time,management of postoperative fever and avoid hypoxemia may contribute to reduce the incidence of postoperative delirium.
引文
[1] Radcliff K,Ong K L,Lovald S,et al. Cervical spine surgery complications and risks in the elderly[J]. Spine,2017,42(6):E347-E354.
[2] Lee D S,Lee M Y,Park C M,et al. Park preoperative statins are associated with a reduced risk of postoperative delirium following vascular surgery[J]. PLo S One,2018,13(3):e0192841.
[3]马昊,欧阳文,莫逸,等.术后谵妄老年病人脑葡萄糖代谢的变化及右美托咪定对其影响[J].中华麻醉学杂志,2012,32(12):1417-1420.
[4] Rudolph J L,Marcantonio E R. Postoperative delirium:acute change with long-term implications[J]. Anesth Analg,2011,112(5):1202-1211.
[5] Ansaloni L,Catena F,Chattat R,et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery[J]. Br J Surg,2010,97(2):273-280.
[6]王娟,李志伟,余雨,等.老年患者脊柱手术后谵妄的危险因素分析[J].重庆医科大学学报,2015,40(5):721-724.
[7] Lee J K,Park Y S. Delirium after spinal surgery in Korean population[J]. Spine,2010,35(18):1729-1732.
[8] Seo J S,Park S W,Lee Y S,et al. Risk factors for delirium after spine surgery in elderly patients[J]. J Korean Neurosurg Soc,2014,56(1):28-33.
[9] Brown C H,La Flam A,Max L,et al. Delirium after spine surgery in older adults:Incidence,risk,and outcomes[J]. J Am Geriatr Soc,2016,64(10):2101-2108.
[10] Shi C,Yang C,Gao R,et al. Risk factors for delirium after spinal surgery:A Meta-analysis[J]. World Neurosurg,2015,84(5):1466-1472.
[11] Dlugaj M,Winkler A,Weimar C,et al. Anemia and mild cognitive impairment in the German general population[J]. J Alzheimers Dis,2016,49(4):1031-1042.
[12]李宏,李淳德,邑晓东,等.高龄患者脊柱术后谵妄状态的高危因素分析[J].北京大学学报(医学版),2012,44(6):847-850.
[13] Gao R,Yang Z Z,Li M,et al. Probable risk factors for postoperative delirium in patients undergoing spinal surgery[J]. Eur Spine J,2008,17(11):1531-1537.
[14]丁喆如,符培亮,吴宇黎,等.老年患者置换术后发生急性精神障碍的原因分析[J].中华关节外科杂志,2015,9(4):445-448.
[15]王利宏,徐国红,韦仙姣,等.骨科常见手术术后谵妄的危险因素分析[J].中华骨科杂志,2015,35(6):650-655.
[16]鲍宏玮,严力生,陈红梅,等.麻醉选择对老年人髋部骨折术后谵妄的影响[J].中国骨与关节损伤杂志,2016,31(4):393-394.
[17] Mason S E,Noel-Storr A,Ritchie C W. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium:a systematic review with meta-analysis[J]. J Alzheimers Dis,2010,22(3):67-69.
[2] Lee D S,Lee M Y,Park C M,et al. Park preoperative statins are associated with a reduced risk of postoperative delirium following vascular surgery[J]. PLo S One,2018,13(3):e0192841.
[3]马昊,欧阳文,莫逸,等.术后谵妄老年病人脑葡萄糖代谢的变化及右美托咪定对其影响[J].中华麻醉学杂志,2012,32(12):1417-1420.
[4] Rudolph J L,Marcantonio E R. Postoperative delirium:acute change with long-term implications[J]. Anesth Analg,2011,112(5):1202-1211.
[5] Ansaloni L,Catena F,Chattat R,et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery[J]. Br J Surg,2010,97(2):273-280.
[6]王娟,李志伟,余雨,等.老年患者脊柱手术后谵妄的危险因素分析[J].重庆医科大学学报,2015,40(5):721-724.
[7] Lee J K,Park Y S. Delirium after spinal surgery in Korean population[J]. Spine,2010,35(18):1729-1732.
[8] Seo J S,Park S W,Lee Y S,et al. Risk factors for delirium after spine surgery in elderly patients[J]. J Korean Neurosurg Soc,2014,56(1):28-33.
[9] Brown C H,La Flam A,Max L,et al. Delirium after spine surgery in older adults:Incidence,risk,and outcomes[J]. J Am Geriatr Soc,2016,64(10):2101-2108.
[10] Shi C,Yang C,Gao R,et al. Risk factors for delirium after spinal surgery:A Meta-analysis[J]. World Neurosurg,2015,84(5):1466-1472.
[11] Dlugaj M,Winkler A,Weimar C,et al. Anemia and mild cognitive impairment in the German general population[J]. J Alzheimers Dis,2016,49(4):1031-1042.
[12]李宏,李淳德,邑晓东,等.高龄患者脊柱术后谵妄状态的高危因素分析[J].北京大学学报(医学版),2012,44(6):847-850.
[13] Gao R,Yang Z Z,Li M,et al. Probable risk factors for postoperative delirium in patients undergoing spinal surgery[J]. Eur Spine J,2008,17(11):1531-1537.
[14]丁喆如,符培亮,吴宇黎,等.老年患者置换术后发生急性精神障碍的原因分析[J].中华关节外科杂志,2015,9(4):445-448.
[15]王利宏,徐国红,韦仙姣,等.骨科常见手术术后谵妄的危险因素分析[J].中华骨科杂志,2015,35(6):650-655.
[16]鲍宏玮,严力生,陈红梅,等.麻醉选择对老年人髋部骨折术后谵妄的影响[J].中国骨与关节损伤杂志,2016,31(4):393-394.
[17] Mason S E,Noel-Storr A,Ritchie C W. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium:a systematic review with meta-analysis[J]. J Alzheimers Dis,2010,22(3):67-69.