老年肝脏手术患者术后谵妄的危险因素分析  

Risk factors of postoperative delirium in elderly patients undergoing liver surgery under general anesthesia

作　　者：徐惠[1] 杨静[1] 王蕊 XU Hui;YANG Jing;WANG Rui(Center of Anesthesia Operation,West China Hosptial of Sichuan University,West China College of Nursing,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院麻醉科/华西护理学院,四川成都610041

出　　处：《川北医学院学报》2022年第2期244-247,共4页Journal of North Sichuan Medical College

摘　　要：目的:探讨老年肝脏手术患者术后谵妄(POD)的危险因素。方法:选取267例老年肝脏手术患者为研究对象,根据患者术后48 h内是否发生POD分为POD组(n=44)和NPOD组(n=223)。比较两组患者术前及术中、术后相关因素的占比;单因素相关分析和Logistic回归分析法分析老年肝脏手术患者发生POD的危险因素。结果:老年肝脏手术患者POD发生率为16.48%(44/267),其中24 h内发生37例,24~48 h内发生7例。术前,POD组患者男性、年龄≥70岁、高美国麻醉医师协会(ASA)分级(Ⅲ、Ⅳ级)及合并有糖尿病、贫血、睡眠周期紊乱、酗酒史患者的比例高于NPOD组(P<0.05);平均体质量指数(BMI)低于NPOD组(P<0.05)。术中及术后,POD组患者行开腹手术、术中失血量≥400 mL、术后中度以上疼痛(VAS疼痛评分≥4分)、术后48 h内发生低氧血症患者比例高于NPOD组(P<0.05)。回归分析显示,高龄、低BMI、ASA高分级及术前合并糖尿病、贫血、睡眠紊乱及有酗酒史和术后中度以上疼痛、48 h内发生低氧血症是老年肝脏手术患者发生POD的危险因素。结论:术前高龄、低BMI、ASA高分级、合并糖尿病、酗酒史,术前贫血、睡眠紊乱、术后中度以上疼痛及术后48 h内发生低氧血症为老年肝脏手术患者POD发生的危险因素,临床应针对高危因素积极预防干预。Objective:To explore the risk factors of postoperative delirium(POD)in elderly patients undergoing liver surgery under general anesthesia.Methods:A total of 267 elderly patients who underwent liver surgery were selected.According to whether POD occurred within 48 hours after operation,the patients were divided into POD group(n=44)and NPOD group(n=223).The proportions of preoperative,intraoperative and postoperative related factors were compared between the two groups.Univariate correlation analysis and logistic regression analysis were used to analyze the risk factors of POD in elderly patients undergoing liver surgery.Results:The incidence of POD in this study was 16.48%(44/267),including 37 cases within 24 hours and 7 cases within 24~48 hours.Before surgery,the proportion of males,age≥70 years,patients with high ASA grade(gradeⅢ,gradeⅣ),with diabetes mellitus,anemia,sleep cycle disorder and alcoholism history in POD group were higher than those in NPOD group(P<0.05),and BMI was lower than that in NPOD group(P<0.05).During and after operation,the proportion of patients undergoing laparotomy,patients with intraoperative blood loss≥400mL,postoperative moderate pain(VAS pain score≥4 points)and hypoxemia within 48 hours in POD group were higher than those in NPOD group(P<0.05).Logistic regression analysis showed that age,low BMI,ASA high grade and preoperative diabetes mellitus,anemia,sleep disorder and history of alcoholism,postoperative moderate pain and hypoxemia within 48 h were risk factors for POD in elderly patients undergoing liver surgery.Conclusion:Preoperative advanced age,low BMI,ASA high grade,diabetes mellitus,history of alcoholism,preoperative anaemia,sleep disorders,postoperative moderate pain and hypoxemia within 48 h after operation are risk factors for POD in elderly patients undergoing liver surgery,clinical prevention and intervention should be actively aimed at high-risk factors.

关 键 词：术后谵妄 肝脏手术 老年 危险因素 预防 

分 类 号：R338.63[医药卫生—人体生理学]