老年结直肠癌患者根治手术术后谵妄发生的影响因素分析  

Analysis of influencing factors of delirium after radical operation of colorectal cancer in elderly patients

作　　者：施敏[1] 邓薇[1] 陈红[1] 王锦[1] 高蔚 卢昕[1] 李晓辉[1] Shi Min;Deng Wei;Chen Hong;Wang Jin;Gao Wei;Lu Xin;Li Xiaohui(Department of Gastrointestinal Surgery,Wuhan First Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院胃肠外科,武汉430022

出　　处：《肿瘤综合治疗电子杂志》2022年第4期66-70,共5页Journal of Multidisciplinary Cancer Management(Electronic Version)

摘　　要：目的 分析老年结直肠癌患者根治手术术后谵妄(postoperative delirium,POD)发生的影响因素。方法 选取2017年1月至2022年4月武汉市第一医院收治的188例老年结直肠癌根治术患者为研究对象,根据术后意识错乱评估法结果将其分为POD组和非POD组,比较两组患者的临床资料,采用多因素Logistic回归分析探讨老年结直肠癌根治术患者POD发生的独立影响因素。结果 全部患者术后1周内共有26例发生POD,发生率为13.8%,多在术后3 d内发生(76.9%),以高活动型为主(57.7%)。POD组年龄、男性、初中及以下文化程度、美国麻醉医师协会分级为Ⅲ级、有酗酒史、有脑血管病病史、术前预后营养指数(prognostic nutritional index,PNI)<45、术中低氧、围手术期输血的比例均显著高于非POD组(均P<0.05),手术时间、术后住院天数均显著长于非POD组(均P<0.05),术前血红蛋白、左室射血分数均显著低于非POD组(均P<0.05)。多因素Logistic回归分析结果表明,年龄、术中缺氧、术前PNI<45均为老年结直肠癌患者根治性手术后发生POD的独立影响因素(均P<0.05)。结论 老年结直肠癌患者根治性手术后发生POD并不少见,年龄、术中缺氧、术前PNI<45均为此类患者POD发生的独立影响因素,营养不良与POD的发生有关。Objective To analysis the influencing factors of postoperative delirium (POD) in elderly patients with colorectal cancer after radical operation.Method One hundred and eighty-eight elderly patients who underwent radical operation of colorectal cancer in Wuhan First Hospital from January 2017 to April 2022 were enrolled for the research and divided into POD group and non-POD group according to the result of postoperative confusion assessment method.The clinical data was compared between the two groups.Multivariate Logistic regression was performed to analyze the independent influencing factors of POD in elderly patients with colorectal cancer after radical operation.Result POD occurred in 26 patients within 1 week after operation,and the incidence was 13.8%.Most of them occurred within 3 days after operation (76.9%),and high activity type (57.7%).The age,the proportion of male,junior high school education or below,American Society of Anesthesiologists grade Ⅲ,history of alcoholism,history of cerebral vasculardisease,preoperative prognostic nutritional index (PNI)<45,intraoperative hypoxia and perioperative blood transfusion in POD group were significantly higher than those in non-POD group (all P<0.05),the operation time and postoperative hospital day were significantly longer than those in non-POD group (all P<0.05),and preoperative hemoglobin and left ventricular ejection fraction were significantly lower than those in non-POD group (all P<0.05).Multivariate Logistic regression analysis showed that age,intraoperative hypoxia and preoperative PNI<45 were all independent influencing factors for POD in elderly patients with colorectal cancer after radical operation (all P<0.05).Conclusion It is not uncommon for elderly patients with colorectal cancer to develop POD after operation.Age,intraoperative hypoxia and preoperative PNI<45 are the independent factors affecting POD,and malnutrition is related to POD.

关 键 词：预后营养指数 结直肠癌根治术 术后谵妄 老年 影响因素 

分 类 号：R735.34[医药卫生—肿瘤]