腹腔镜下子宫切除术老年贫血病人发生术后谵妄的影响因素分析  

Analysis of influencing factors of postoperative delirium in elderly patients with anemia after laparoscopic hysterectomy

作　　者：纪玮玮 刘伟 饶丽华 苗民 陈斌 胡北 JI Wei-wei;LIU Wei;RAO Li-hua;MIAO Min;CHEN Bin;HU Bei(Department of Anesthesiology, Suqian People′s Hospital of Nanjing Drum-Tower Hospital Group, Suqian 223800, China)

机构地区：[1]南京鼓楼医院集团宿迁医院麻醉科,江苏省宿迁市223800

出　　处：《实用老年医学》2022年第7期702-705,共4页Practical Geriatrics

摘　　要：目的探究行腹腔镜下子宫切除术术前血红蛋白为70~110 g/L的老年病人术后谵妄(POD)的发生情况及其影响因素。方法选取2019年1月至2021年5月于我院全麻下行腹腔镜下子宫切除术术前血红蛋白为70~110 g/L的老年病人297例为研究对象,观察术后7 d内病人POD的发生情况,并分析其影响因素。结果297例病人中,76例发生了POD,POD的发生率为25.59%。多因素Logistic回归分析结果提示年龄≥70岁、静吸复合麻醉、术前血红蛋白为70~89 g/L、二氧化碳(CO_(2))气腹时间>90 min、术中未应用右美托咪定、术后6 h SpO_(2)≤95%以及术后VAS评分>3分是术前血红蛋白为70~110 g/L的老年病人行腹腔镜下子宫切除术后发生POD的独立危险因素。结论全麻下行腹腔镜下子宫切除术术前血红蛋白为70~110 g/L的老年病人的POD发生率较高,其与病人的年龄、麻醉方式、术前血红蛋白水平、术中CO_(2)气腹时间、术后SpO_(2)、术后疼痛情况及术中是否应用右美托咪定等关系密切。Objective To investigate the incidence and the influencing factors of postoperative delirium(POD)in the elderly patients with hemoglobin of 70-110 g/L who underwent laparoscopic hysterectomy.Methods A total of 297 elderly patients with preoperative hemoglobin of 70-110 g/L receiving laparoscopic hysterectomy under general anesthesia in our hospital from January 2019 to May 2021 were enrolled.The incidence of POD in the patients within 7 days after operation was observed and its influencing factors were analyzed.Results Among the 297 patients,76 patients presented with POD after operation,and the incidence rate of POD was 25.59%.Multivariate Logistic regression analysis showed that aged≥70 years old,combined intravenous and inhaled anesthesia,preoperative hemoglobin ranging 70-89 g/L,carbon dioxide(CO_(2))pneumoperitoneum time>90 min,no application of dexmedetomidine during operation,oxygen saturation(SpO_(2))≤95%within 6 hours after operation and postoperative visual analogue score(VAS)>3 were the independent risk factors of POD in the elderly patients with hemoglobin of 70-110 g/L who underwent laparoscopic hysterectomy.Conclusions The incidence of POD in the elderly patients with hemoglobin of 70-110 g/L receiving laparoscopic hysterectomy under general anesthesia is high,which is closely related to the patient’s age,anesthesia mode,preoperative hemoglobin level,intraoperative CO_(2) pneumoperitoneum time,postoperative SpO_(2),postoperative pain and intraoperative use of dexmedetomidine.

关 键 词：贫血 腹腔镜下子宫切除术 术后谵妄 影响因素 老年人 

分 类 号：R556.1[医药卫生—血液循环系统疾病]