神经外科重症患者术后谵妄的危险因素分析  

Analysis of risk factors for delirium in severe patients after neurosurgery

作　　者：冯雅笛 蔡卫新[1] 王会文[2] 张冉[1] 李京连 曹炜[1] FENG Yadi;CAI Weixin;WANG Huiwen;ZHANG Ran;LI Jinglian;CAO Wei(Intensive Care Unit,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,100070 [2]首都医科大学附属北京天坛医院麻醉科,100070

出　　处：《临床麻醉学杂志》2020年第9期876-880,共5页Journal of Clinical Anesthesiology

基　　金：天坛医院2016年度院青年科研基金(2016-YQN-28)。

摘　　要：目的分析和探讨神经外科重症患者发生术后谵妄的危险因素。方法本研究采用连续入组方便取样的方法,纳入符合入选标准的患者。统计术中出血量与手术时间、术后血红蛋白、白蛋白、淋巴细胞相对值、中性粒细胞相对值、红细胞压积、体温、机械通气时间、格拉斯哥昏迷评分(GCS)和二氧化碳结合力等,应用意识模糊评估法(CAM-ICU)对患者进行评估,采用多因素Logistic回归分析术后谵妄的危险因素。结果本研究共纳入130例患者,其中谵妄患者58例(谵妄组),余72例患者纳入非谵妄组。单因素分析显示:谵妄组患者的术后血红蛋白、白蛋白、红细胞压积、GCS评分和二氧化碳结合力明显低于非谵妄组,术后淋巴细胞相对值、中性粒细胞相对值、体温明显高于非谵妄组,机械通气时间明显长于非谵妄组(P<0.05)。Logistic多元回归分析显示:体温(OR=2.261,95%CI 1.094~4.673,P=0.028)、机械通气时间(OR=1.006,95%CI 1.002~1.009,P=0.001)、GCS评分(OR=1.436,95%CI 1.211~1.703,P<0.001)和二氧化碳结合力(OR=1.176,95%CI 1.086~1.274,P<0.001)是神经外科重症患者谵妄的独立危险因素。结论随着体温升高、机械通气时间延长、GCS评分降低和二氧化碳结合力降低,神经外科重症患者谵妄的发生率增高。Objective To investigate the delirium risk factors in severe patients with neurosurgery.Methods This study used a method of continuous sampling to facilitate sampling.Intraoperative blood loss and operation time,postoperative hemoglobin,albumin,relative value of lymphocytes,relative value of neutrophils,hematocrit,carbon dioxide binding capacity,tube time,body temperature,and GCS score were applied.The ICU assessed patients and collected baseline data from the patients.Multivariate Logistic regression was used to analyze the independent risk factors of delirium after surgery.Results A total of 130 patients who met the selection criteria were included in delirium group(n=58)and non-delirium group(n=72).Univariate analysis showed that patients with delirium had lower postoperative hemoglobin,albumin,hematocrit,carbon dioxide binding capacity,and GCS scores than those without delirium.The relative values of lymphocytes,neutrophils,time of mechanical ventilation and body temperature were higher than those in non-delirium group after operation(P<0.05).Logistic multiple regression analysis showed that Body temperature(OR=2.261,95%CI 1.094-4.673,P=0.028),Mechanical ventilation time(OR=1.006,95%CI 1.002-1.009,P=0.001),GCS score(OR=1.436,95%CI 1.211-1.703,P<0.001)and Carbon dioxide binding capacity(OR=1.176,95%CI 1.086-1.274,P<0.001)were independent risk factors of delirium in patients with neurosurgery critical.Conclusion With the increase of body temperature,the increase of mechanical ventilation time,the decrease of GCS score and the decrease of carbon dioxide binding capacity,the incidence of delirium in patients with severe extrapsychiatric patients increases.

关 键 词：术后谵妄 神经外科 重症患者 危险因素 

分 类 号：R651[医药卫生—外科学]