术前糖化血红蛋白水平与椎管内麻醉老年患者术后谵妄及认知功能障碍的相关性  

Correlation between preoperative HBA1c level with postoperative delirium and cognitive dysfunction in elderly patients under intraspinal anesthesi

作　　者：祁向雯 李洪影 毛珊珊 庞红利[1] QI Xiangwen;LI Hongying;MAO Shanshan;PANG Hongli(Department of Anesthesia and Perioperative Medicine,First Affiliated Hospital of Henan University,Kaifeng,Henan 475000,China)

机构地区：[1]河南大学第一附属医院麻醉与围术期医学科,河南开封475000

出　　处：《检验医学与临床》2023年第19期2822-2825,共4页Laboratory Medicine and Clinic

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190523);河南省教育厅科学技术研究项目(20B320002)。

摘　　要：目的分析术前糖化血红蛋白(HbA1c)水平与椎管内麻醉老年患者术后谵妄(POD)及认知功能障碍(POCD)的相关性。方法选择该院择期行椎管内麻醉膝/髋关节置换术的老年患者125例为研究对象。根据是否发生POD或POCD将患者分为POD组、非POD组,POCD组、非POCD组,检测并比较各组患者术前HbA1c水平差异。采用多因素Logistic回归分析POD、POCD发生的影响因素,采用受试者工作特征(ROC)曲线评价术前HbA1c对POD和POCD的预测价值。结果125例椎管内麻醉老年患者中21例(16.8%)出现POD,30例(24.0%)出现POCD。POD组和POCD组术前HbA1c水平明显高于非POD组和非POCD组(P<0.05)。多因素Logistic回归分析显示,术前HbA1c及年龄、术前简易精神状态量表评分是椎管内麻醉老年患者发生POD的独立影响因素(P<0.05);术前HbA1c及年龄、文化程度是椎管内麻醉老年患者发生POCD的独立影响因素(P<0.05)。ROC曲线分析结果显示,术前HbA1c预测POD和POCD的曲线下面积分别为0.743和0.675。结论术前HbA1c是椎管内麻醉老年患者发生POD和POCD的独立影响因素,且对POD和POCD具有一定的预测价值。Objective To analyze the correlation between preoperative glycated hemoglobin A1c(HbA1c)level with postoperative delirium(POD)and postoperative cognitive dysfunction(POCD)in elderly patients undergoing intraspinal anesthesia.Methods A total of 125 elderly patients undergoing elective knee/hip replacement under intraspinal anesthesia in this hospital were selected as the study subjects and divided into the POD group,non-POD group or POCD group and non-POCD group according to the occurrence of POD or POCD,then the preoperative HbA1c level was detected and the difference was compared between each groups.The multivariate Logistic regression was used to analyze the influencing factors of POD and POCD occurrence.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of preoperative HbA1c for POD and POCD.Results Among 125 elderly patients undergoing spinal anesthesia,POD occurred in 21 cases(16.8%)and POCD occurred in 30 cases(24.0%).The preoperative HbA1c level in the POD group and POCD group was significantly higher than that in the non-POD group and non-POCD(P<0.05).The multivariate Logistic regression analysis showed that preoperative HbA1c level,age and preoperative MMSE score were the independent influencing factors for the POD occurrence in elderly patients undergoing intraspinal anesthesia(P<0.05).Preoperative HbA1c level,age and education level were the independent influencing factors for the POCD occurrence in elderly patients undergoing intraspinal anesthesia(P<0.05).The ROC curve analysis results showed that the areas under the curve of preoperative HbA1c level in predicting POD and POCD were 0.743 and 0.675 respectively.Conclusion Preoperative HbA1c level is an independent influencing factor for the occurrence of POD and POCD in elderly patients undergoing intraspinal anesthesia,and it has a certain predictive value for POD and POCD.

关 键 词：糖化血红蛋白 椎管内麻醉 术后谵妄 认知功能障碍 老年 

分 类 号：R614.3[医药卫生—麻醉学]