非心脏手术老年患者术后谵妄与术前衰弱的关系  

Relationship between postoperative delirium and preoperative frailty in elderly patients undergoing non-cardiac surgery

作　　者：孙贺[1] 乔迎帅 马松梅[1] 冯爱敏[2] Sun He;Qiao Yingshuai;Ma Songmei;Feng Aimin(Department of Anesthesiology,Shangqiu First People′s Hospital,Shangqiu 476400,China;Department of Anesthesiology,Henan Cancer Hospital,Zhengzhou 450000,China)

机构地区：[1]商丘市第一人民医院麻醉科,商丘476400 [2]河南省肿瘤医院麻醉科,郑州450000

出　　处：《中华麻醉学杂志》2023年第1期42-45,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价非心脏手术老年患者术后谵妄与术前衰弱的关系。方法收集2019年3月至2022年7月于本院行非心脏手术老年患者,收集患者年龄、合并疾病、性别、吸烟史、手术类型、术前白蛋白、手术时间、麻醉时间、术后低血压、文化程度、营养状况、ASA分级、术后是否入ICU、术中出血量、术前衰弱状态等病历资料。根据是否发生术后谵妄分为谵妄组和无谵妄组。采用多因素logistic回归分析法筛选术后谵妄发生的危险因素,绘制受试者工作特征(ROC)曲线分析危险因素对术后谵妄的预测价值。结果谵妄组74例,无谵妄组321例,术后谵妄发生率为18.7%。与无谵妄组相比,谵妄组年龄≥70岁、文化程度初中及以下、营养状况差、ASA分级Ⅲ级、术后入ICU、衰弱患者比例和术中出血量差异有统计学意义(P<0.05)。logistic回归分析结果显示,年龄、文化程度、营养状况、ASA分级、术中出血量及衰弱均是谵妄的独立危险因素(P<0.05)。术前衰弱预测术后谵妄的ROC曲线下面积及其95%可信区间为0.672(0.605~0.740)。结论术前衰弱是非心脏手术老年患者术后谵妄的独立危险因素,可在一定程度上预测术后谵妄的发生。Objective To evaluate the relationship between postoperative delirium and preoperative frailty in elderly patients undergoing non-cardiac surgery.Methods Elderly patients undergoing non-cardiac surgery at our hospital from March 2019 to July 2022 were collected and their age,comorbidities,gender,smoking history,type of surgery,preoperative albumin,duration of surgery,duration of anesthesia,postoperative hypotension,educational level,nutritional status,American Society of Anesthesiologists(ASA)Physical Status classification,postoperative admission to ICU or not,intraoperative bleeding and preoperative frailty status were collected.The patients were divided into delirium group and non-delirium group according to whether postoperative delirium occurred.The risk factors for postoperative delirium were analyzed by multivariate logistic regression analysis,and the receiver operating characteristic curve was drawn to analyze the value of risk factors in predicting postoperative delirium.Results There were 74 cases in delirium group and 321 cases in non-delirium group,and the incidence of postoperative delirium was 18.7%.There were statistically significant differences in terms of age≥70 yr,education level of junior high school and below,poor nutritional status,ASA Physical Status classificationⅢ,postoperative admission to ICU,proportion of frailty and intraoperative bleeding volume between delirium group and non-delirium group(P<0.05).The results of logistic regression analysis showed that age,educational level,nutritional status,ASA Physical Status classification,intraoperative bleeding and frailty were all independent risk factors for delirium(P<0.05).The area under the receiver operating characteristic curve of preoperative frailty predicting postoperative delirium was 0.672(95%confidence interval 0.605-0.740).Conclusions Preoperative frailty is an independent risk factor for postoperative delirium in elderly patients undergoing noncardiac surgery,which can predict the occurrence of postoperative delirium to some

关 键 词：老年人 谵妄 衰弱 非心脏手术 

分 类 号：R614[医药卫生—麻醉学]