血清AchE水平对神经外科普通病区患者谵妄发生的影响  

Influence of serum acetylcholinesterase level in delirium of patients in General Ward of Neurosurgery

作　　者：王紫括 王斌[1] 冯光[1] 尚聪聪 王剑新 Wang Zikuo;Wang Bin;Feng Guang;Shang Congcong;Wang Jianxin(Department of Neurosurgery,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Allergy,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院神经外科,郑州450003 [2]河南省人民医院过敏反应科,郑州450003

出　　处：《中华神经医学杂志》2022年第2期157-163,共7页Chinese Journal of Neuromedicine

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202002001)。

摘　　要：目的探讨神经外科普通病区患者发生谵妄的影响因素并重点评估血清乙酰胆碱酯酶(AchE)水平对其的影响。方法选择自2021年1月至2021年7月于河南省人民医院神经外科行择期手术治疗后入住普通病房的298例患者进入研究,住院期间应用4AT谵妄评分工具评估患者是否发生谵妄,并将患者分为非谵妄组与谵妄组。回顾性收集患者术前的一般资料、既往史及实验室检查结果(如血清AchE水平)等,应用单因素分析及多因素Logistic回归分析明确影响患者术后谵妄发生的独立因素,尤其是明确术前血清AchE水平与其的关系,并绘制受试者工作特征(ROC)曲线评估血清AchE水平对术后谵妄发生的预测价值。结果298例患者中术后谵妄的发生率为24%,其中非谵妄组患者225例、谵妄组患者73例。2组患者间术后入住麻醉ICU复苏比例、术后镇痛泵使用比例、酗酒史比例、手术时间、术中出血量、颅底手术者比例、术后2 h保持清醒者比例、术后双侧额叶积气发生率等方面的差异均有统计学意义(P<0.05),且谵妄组的术前血清AchE水平[(2.35±0.49)U/mL]更明显低于非谵妄组[(2.78±0.48)U/mL],差异有统计学意义(P<0.05)。术前血清AchE水平(OR=0.116,95%CI:0.034~0.394,P=0.001)、术后入住麻醉ICU复苏(OR=0.043,95%CI:0.002~0.878,P=0.041)、术后2 h保持清醒(OR=7.641,95%CI:1.675~34.858,P=0.009)、手术时间(OR=1.887,95%CI:1.192~2.987,P=0.007)、术中出血量(OR=1.010,95%CI:1.006~1.014,P<0.001)、颅底手术(OR=6.700,95%CI:1.907~23.547,P=0.003)均为影响患者术后谵妄发生的独立因素。术前血清AchE水平预测术后谵妄发生的ROC曲线下面积为0.735(95%CI:0.679~0.800,P<0.001),当其截断值取2.67 U/mL时,其灵敏度为64%,特异度为75%。结论行颅底手术、术后2 h仍保持清醒、手术时间长及术中出血量大等均可促进患者术后谵妄的发生,术后入住麻醉ICU复苏可降低谵妄的发生,并且当术前血清AchEObjective To explore the influencing factors for postoperative delirium in General Ward of Neurosurgery and evaluate the influence of serum acetylcholinesterase level in it.Methods A retrospective study was performed.Two hundred and ninety-eight patients accepted surgery and diverted into General Ward of Neurosurgery in our hospital from January 2021 to July 2021 were chosen in our study.The 4AT delirium scoring tool was used to evaluate whether the patients had delirium,and these patients were,then,divided into non-delirium group and delirium group.The preoperative general data,history of deseases and laboratory results(serum acetylcholinesterase level)were collected.Univariate analysis and multivariate Logistic regression analysis were used to determine the independent factors affecting the occurrence of postoperative delirium,especially the relation between preoperative serum acetylcholinesterase level and postoperative delirium.Receiver operating characteristics(ROC)curve was drawn to evaluate the predictive value of serum acetylcholinesterase in postoperative delirium.Results The incidence of postoperative delirium in 298 patients in General Ward of Neurosurgery was 24%,including 225 patients into the non-delirium group and 73 patients into the delirium group.There were significant differences between the two groups in the proportions of patients having resuscitation in anesthesia ICU,using postoperative analgesic pump and having alcoholism history,surgical duration,intraoperative bleeding,proportion of patients accepting skull base surgery,proportion of patients remaining awake 2 h after surgery,and incidence of bilateral frontal lobe pneumatosis after surgery(P<0.05).Preoperative serum acetylcholinesterase level in delirium group([2.35±0.49]U/mL)was significantly lower than that in non-delirium group([2.78±0.48]U/mL,P<0.05).Preoperative serum acetylcholinesterase level(OR=0.116,95%CI:0.034-0.394,P=0.001),postoperative resuscitation in anesthesia ICU(OR=0.043,95%CI:0.002-0.878,P=0.041),keeping awake 2 h a

关 键 词：谵妄 乙酰胆碱酯酶 神经外科手术 危险因素 

分 类 号：R651.1[医药卫生—外科学]