中老年脊柱手术术后谵妄的危险因素分析  

Associated risk facators of postoperative delirium after spine surgery in mid-aged and elderly

作　　者：蒋欣[1] 陈栋[1] 娄雅浩 李中实[1] 

机构地区：[1]卫生部中日友好医院脊柱外科,北京100029

出　　处：《中华骨科杂志》2016年第22期1442-1449,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨中老年患者进行脊柱手术术后谵妄的危险因素。方法2010年1月1日至2015年8月10日排除所有伴有中枢神经系统疾病或精神疾病的患者后，共有451例因脊柱疾病接受手术治疗的中老年患者被纳入研究，男226例，女225例；年龄45-84岁，平均年龄（65．1±18．3）岁。术后患者的谵妄与否采用临床谵妄评级（clinical dementia rating，CDR）以及全面衰退量表（global deterioration scale，GDS）评分标准，根据结果分为谵妄组和无谵妄组，对两组的术前指标（年龄，性别，受教育程度，服药情况，体重指数，饮酒情况，是否合并高血压、糖尿病、肺部疾病或慢性肾病以及肝病，既往手术史，血压，血红蛋白，红细胞压积以及血生化指标）和术中指标（手术时间，失血量，术中输血量，是否使用内固定，术中血压，以及芬太尼、异丙酚和地佐辛的用量）采用PASW Statistics 18．0统计软件进行统计学分析，有统计学意义的指标代人多因素Logistic回归分析，以确定术后谵妄的危险因素。结果发生术后谵妄42例（9．31％），31例发生于术后第1天，11例发生于术后第2天。谵妄组的平均年龄（66．3±14．4）岁，男女比例1：1．1；无谵妄组平均年龄（66．7±15．5）岁，男女比例1．01：1。谵妄组和无谵妄组在术中发生低血压（〈80mmHg）次数以及地佐辛的用量上有显著性差异，多元回归分析分析结果显示地佐辛用量（95％CI，0-31-0．75）和术中低血压次数（95％CI，1．0-2．1）是术后谵妄的独立危险因素，多元回归方程Y=-0．11±0．02X0±0．21X1，X0为地佐辛用量，X1为术中低血压次数，危险系数0．43，说明危险因素与术后谵妄中度相关。结论术中发生低血压次数以及地佐辛用量是中老年脊柱手术术后谵妄的独立危险因素，需要在临床工作中应特别注意维持术中血压稳定、慎重使用Objective Analyzed various risk factors for postoperative delirium after spine surgery in the mid-aged and elderly. Methods Between January 2010 and August 2015, a total of 451 patients （226 males and 225 females） with an average age of （65.1 ± 18.3） years （range 45-84 years） and who underwent spinal surgery in Chinese-Japanese Friendship Hospital were reviewed retrospectively, and patients with central nerve system disease or psychiatric disorders were excluded in study. All patients underwent the surgical procedures including fusion operation, decompressive lamineetomy and discectomy of the lumbar spine, anterior cervical diseectomy and fusion, laminoplasty and foraminotomy of the cervical spine. Cognition tests such as Clinical Dementia Rating （CDR） and Global Deterioration Scale （GDS） were used to evaluate delirium, and all patients were subgrouped into delirium group and non-delirium group. Preoperative factors included age, education level, drug treatment, BMI index, alcohol use, comorbid diseases, surgical history, surgical site, systolic blood pressure （SBP）, hemoglobin （HGB）, hematocrit （HCT）, and blood biochemistry indexes, intraoperative factors including operative time, blood loss, blood transfusion, use of surgical implants, times of intraoperative hypotension 〈 80 mmHg and use of fentanyl, propofol and dezocine. PASW Statistics 18.0 software were used for statistical analysis of the difference between 2 groups, and logistic regression analysis was used for determining the risk factors. Results There were 42 （9.31%） patients in delirium group. 31 cases were diagnosed on the first postoperative day, while 11 on the second postoperative day. The average age of the patients in delirium group was 66.3±14.4 years, the male/female ratio was 1 ： 1.1 （20：22）. The average age in non-delirium group was 66.7± 15.5 years, and the male/female ratio was 1.01 ： 1 （206：203）. Intraoperative hypotension and dosage of dezocine had significant differences between

关 键 词：谵妄 脊柱疾病 低血压 危险因素 

分 类 号：R687.3[医药卫生—骨科学]