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  

Study on correlation of postoperative delirium and leukoaraiosis in elderly patients undergoing orthopedic surgery

作　　者：于晓燕[1] 黄国祥[1] 陈佳佳[1] 曹志勇[1] 宋杰[1] YU Xiaoyan;HUANG Guoxiang;CHEN Jiajia;CAO Zhiyong;SONG Jie(The First People’s Hospital of Nantong,Nantong 226000,Jiangsu,China)

机构地区：[1]江苏省南通市第一人民医院

出　　处：《现代中西医结合杂志》2019年第22期2425-2428,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：南通市科技计划项目(MS120170041)

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.

关 键 词：术后谵妄 骨科 老年人 脑白质疏松症 危险因素 

分 类 号：R68[医药卫生—骨科学]