老年骨科手术患者术后谵妄与脑白质疏松症的相关性研究
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摘要
目的探讨老年骨科手术患者术后谵妄的危险因素以及与脑白质疏松的相关性。方法收集120例65岁以上老年骨科手术患者的资料,按术后是否出现谵妄将患者分为术后谵妄组和无术后谵妄组,根据脑MRI评价2组患者脑白质疏松程度并进行评分,比较2组患者人口统计学和临床特征,采用多因素Logistic回归分析寻找老年骨科患者术后谵妄的独立危险因素,Spearman法分析脑白质疏松分级与术后谵妄评分的相关性。结果术后谵妄组44例,无术后谵妄组76例。术后谵妄组患者的年龄明显大于无术后谵妄组(P<0.05),脑白质疏松评分明显高于无术后谵妄组(P<0.05),手术时间明显长于无术后谵妄组(P<0.05),有吸烟史、中度脑白质疏松、重度脑白质疏松的患者构成比均明显高于无术后谵妄组(P均<0.05)。多因素Logistic回归分析显示,年龄(OR=1.317,P=0.000)、中度脑白质疏松(OR=0.688,P=0.010)、重度脑白质疏松(OR=0.712,P=0.005)是术后谵妄的独立危险因素。Spearman法分析显示脑白质疏松分级与术后谵妄评分呈正相关(r=0.193,P=0.000)。结论年龄、中度脑白质疏松、重度脑白质疏松是老年骨科手术患者术后谵妄的独立危险因素,且脑白质疏松程度越重,术后谵妄的程度越重。
Objective It is to investigate the risk factors for postoperative delirium(POD) and its correlation with leukoaraiosis(LA) in elderly patients undergoing orthopedic surgery. Methods The data of 120 elderly patients who were over 65 years old and underwent orthopedic surgery were collected. The patients were divided into POD group and N-POD group according to the occurrence of postoperative delirium. The degree of leukoaraiosis was evaluated and graded by using cranial MRI. The demographic and clinical characteristics of the two groups were compared. The independent risk factors of postoperative delirium in elderly orthopedic patients were analyzed by multivariate logistic regression. Spearman's method was used to analyze the correlation between leukoaraiosis grading and postoperative sputum score. Results There were 44 patients in POD group and 76 patients in N-POD group. The age of POD group was older than that of N-POD group(P<0.05); the white matter damage score of POD group was higher than that of N-POD group(P<0.05); the length of operation of POD group was longer than that of N-POD group(P<0.05). The proportion of smoking history, moderate leukoaraiosis and severe leukoaraiosis of POD group was significantly higher than that of N-POD group(P<0.05). Multivariate logistic regression analysis showed that age(OR=1.317, P=0.000), moderate leukoaraiosis(OR=0.688, P=0.010) and severe leukoaraiosis(OR=0.712, P=0.005) were independent risk factors for postoperative delirium. Spearman analysis showed that LA grading was positively correlated with postoperative delirium score(rs=0.193, P=0.000). Conclusion Age, moderate leukoaraiosis and severe leukoaraiosis are independent risk factors for POD in elderly patients undergoing orthopedic surgery. The more severe the degree of LA is, the higher the severity of postoperative delirium will be.
Objective It is to investigate the risk factors for postoperative delirium(POD) and its correlation with leukoaraiosis(LA) in elderly patients undergoing orthopedic surgery. Methods The data of 120 elderly patients who were over 65 years old and underwent orthopedic surgery were collected. The patients were divided into POD group and N-POD group according to the occurrence of postoperative delirium. The degree of leukoaraiosis was evaluated and graded by using cranial MRI. The demographic and clinical characteristics of the two groups were compared. The independent risk factors of postoperative delirium in elderly orthopedic patients were analyzed by multivariate logistic regression. Spearman's method was used to analyze the correlation between leukoaraiosis grading and postoperative sputum score. Results There were 44 patients in POD group and 76 patients in N-POD group. The age of POD group was older than that of N-POD group(P<0.05); the white matter damage score of POD group was higher than that of N-POD group(P<0.05); the length of operation of POD group was longer than that of N-POD group(P<0.05). The proportion of smoking history, moderate leukoaraiosis and severe leukoaraiosis of POD group was significantly higher than that of N-POD group(P<0.05). Multivariate logistic regression analysis showed that age(OR=1.317, P=0.000), moderate leukoaraiosis(OR=0.688, P=0.010) and severe leukoaraiosis(OR=0.712, P=0.005) were independent risk factors for postoperative delirium. Spearman analysis showed that LA grading was positively correlated with postoperative delirium score(rs=0.193, P=0.000). Conclusion Age, moderate leukoaraiosis and severe leukoaraiosis are independent risk factors for POD in elderly patients undergoing orthopedic surgery. The more severe the degree of LA is, the higher the severity of postoperative delirium will be.
引文
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[15] Dickie DA,Ritchie SJ,Cox SR,et al.Vascular risk factors and progression of white matter hyperintensities in the Lothian Birth Cohort 1936[J].Neurobiol Aging,2016,42(42):116-123
[16] Arvanitakis Z,Fleischman DA,Arfanakis K,et al.Association of white matter hyperintensities and gray matter volume with cognition in older individuals without cognitive impairment[J].Brain Struct Funct,2016,221(4):2135-2146
[17] Gilberti N,Gamba M,Premi E,et al.Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke[J].J Neurol,2017,264(3):448-452
[18] Hawkins KA,Emadi N,Pearlson GD,et al.Hyperinsulinemia and elevated systolic blood pressure independently predict white matter hyperintensities with associated cognitive decrement in the middle-aged offspring of dementia patients[J].Metab Brain Dis,2017,32(3):849-857
[2] 刘丹,王东信.危重患者术后谵妄对远期生存率的影响[J].重庆医学,2015,44(9):1229-1231
[3] 中华医学会老年医学分会.老年患者术后谵妄防治中国专家共识[J].中华老年医学杂志,2016,35(12):1257-1262
[4] 钟婷婷,周华东.脑白质疏松症发病机制及临床特点的研究进展[J].中华解剖与临床杂志,2017,22(2):171-175
[5] Charidimou A,Boulouis G,Haley K,et al.White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensive arteriopathy[J].Neurol,2016,86(6):505-511
[6] Schmidt R,Fazekas F,Offenbacher H,et al.Magnetic resonance imaging white matter lesions and cognitive impairment in hypertensive individuals[J].Arch Neurol,1991,48(4):417-420
[7] Hollinger A,Siegemund M,Goettel N,et al.Postoperative Delirium in Cardiac Surgery:An Unavoidable Menace?[J].J Cardiothorac Vasc Anesth,2015,29(6):1677-1687
[8] Umholtz M,Nader ND.Anesthetic Immunomodulation of the Neuroinflammation in Postoperative Cognitive Dysfunction[J].Immunol Invest,2017,46(8):805-815
[9] 武姗姗,张宗旺.术后谵妄神经炎症机制的研究进展[J].国际麻醉学与复苏杂志,2016,37(11):1052-1056
[10] Dillon ST,Vasunilashorn SM,Ngo L,et al.Higher C-Reactive Protein Levels Predict Postoperative Delirium in Older Patients Undergoing Major Elective Surgery:A Longitudinal Nested Case-Control Study[J].Biol Psychiatry,2016,81(2):145-153
[11] Egberts A,Fekkes D,Wijnbeld EH,et al.Disturbed Serotonergic Neurotransmission and Oxidative Stress in Elderly Patients with Delirium[J].Dement Geriatr Cogn Dis Extra,2015,5(3):450-458
[12] 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
[13] 文雯,迟猛,王国年.术后谵妄与神经递质[J].临床麻醉学杂志,2014,30(10):1037-1040
[14] American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults.American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults[J].J Am Geriatr Soc,2015,63(1):142-150
[15] Dickie DA,Ritchie SJ,Cox SR,et al.Vascular risk factors and progression of white matter hyperintensities in the Lothian Birth Cohort 1936[J].Neurobiol Aging,2016,42(42):116-123
[16] Arvanitakis Z,Fleischman DA,Arfanakis K,et al.Association of white matter hyperintensities and gray matter volume with cognition in older individuals without cognitive impairment[J].Brain Struct Funct,2016,221(4):2135-2146
[17] Gilberti N,Gamba M,Premi E,et al.Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke[J].J Neurol,2017,264(3):448-452
[18] Hawkins KA,Emadi N,Pearlson GD,et al.Hyperinsulinemia and elevated systolic blood pressure independently predict white matter hyperintensities with associated cognitive decrement in the middle-aged offspring of dementia patients[J].Metab Brain Dis,2017,32(3):849-857