神经外科脑胶质瘤患者发生术后谵妄的危险因素分析  

Risk factors of postoperative delirium in neurosurgical patients with glioma

作　　者：曹炜[1] 王翠雪 Cao Wei;Wang Cuixue(Intensive Care Unit,Beijing Tiantan Hospital,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

出　　处：《中华现代护理杂志》2020年第34期4763-4768,共6页Chinese Journal of Modern Nursing

摘　　要：目的分析神经外科脑胶质瘤切除患者发生术后谵妄的危险因素,为临床预防谵妄提供依据。方法采用前瞻性队列研究的方法,选取2017年3月—2018年2月在北京某三甲医院ICU的286例成年脑胶质瘤患者作为研究对象,于术后第1~3天采用ICU意识模糊评估法(CAM-ICU)进行谵妄评估,每日2次,同时采集患者的术前、术中、术后早期临床资料以及神经外科专科资料作为与发生术后谵妄可能有关的潜在危险因素。采用单因素分析和二项Logistic回归分析探讨患者发生术后谵妄的危险因素。结果108例患者于术后1~3 d内发生术后谵妄,发生率为37.8%(108/286)。术后约束(OR=4.02,95%置信区间:1.03~17.50,P=0.021)、肿瘤体积(OR=1.19,95%置信区间:0.82~1.71,P=0.044)、肿瘤部位(OR=2.01,95%置信区间:1.03~3.95,P=0.026),以及术前中线移位(OR=1.16,95%置信区间:0.29~4.58,P=0.032)为患者发生术后谵妄的独立危险因素。结论脑胶质瘤切除患者术后谵妄发生率较高;术前影像学提示肿瘤体积大、位于额叶以及术前中线移位的患者可能是发生术后谵妄的高危人群;护理人员在围手术期护理过程中应意识到约束对于谵妄发生的危害,进一步优化术后护理策略。Objective To analyze the risk factors of postoperative delirium in neurosurgical patients with glioma resection so as to provide a basis for clinical to prevent delirium.Methods The prospective cohort study was used and 286 adult glioma patients in Intensive Care Unit (ICU) of a Class Ⅲ Grade A hospital in Beijing from March 2017 to February 2018 were selected as the research object. We carried out delirium evaluation with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) on the first to third day after surgery, twice a day. At the same time, patients' preoperative, intraoperative, and early postoperative clinical data as well as neurosurgery data were collected as potential risk factors that may be related to the occurrence of postoperative delirium. Univariate analysis and binary Logistic regression analysis were used to explore the risk factors of postoperative delirium.Results Postoperative delirium occurred in 108 patients within one to three days after surgery, and the incidence was 37.8% (108/286) . The independent risk factors for postoperative delirium of patients included restraint after surgery [OR=4.02, 95% Confidence Interval (CI) 1.03-17.50, P=0.021], tumor volume (OR=1.19, 95% CI 0.82-1.71, P=0.044) , tumor location (OR=2.01, 95% CI 1.03-3.95, P=0.026) and preoperative midline shift (OR=1.16, 95% CI 0.29-4.58, P=0.032) .Conclusions The incidence of delirium after glioma resection is high. Preoperative imaging shows that patients with large tumors, tumors located in the frontal lobe and preoperative midline shift may be a high-risk group for postoperative delirium. Nurses should be aware of the hazards of restraint to delirium during the perioperative nursing process, and further optimize the postoperative nursing strategy.

关 键 词：手术后并发症 神经外科 脑胶质瘤 术后谵妄 危险因素 

分 类 号：R473.73[医药卫生—护理学]