合并陈旧性脑梗死老年患者术后谵妄的危险因素分析  

Risk factors of postoperative delirium in elderly patients with old cerebral infarction

作　　者：汪娜[1] 赵泽宇 马国威 彭萱 陈可馨 陶勇[1] WANG Na;ZHAO Zeyu;MA Guowei;PENG Xuan;CHEN Kexin;TAO Yong(Department of Anesthesiology,West China(Airport)Hospital Sichuan University,Chengdu,Sichuan 610200,China;Department of Anesthesiology,Sichuan Bayi Rehabilitation Center/Sichuan Provincial Rehabilitation Hospital,Chengdu,Sichuan 611135,China)

机构地区：[1]四川大学华西空港医院/成都市双流区第一人民医院麻醉科,成都610200 [2]四川省八一康复中心/四川省康复医院麻醉科,成都611135

出　　处：《重庆医学》2023年第20期3110-3114,共5页Chongqing medicine

基　　金：四川省卫生健康委基金项目(19PJ255)。

摘　　要：目的探讨合并陈旧性脑梗死老年患者术中局部脑氧饱和度(rScO_(2))和中枢神经特异性蛋白(S-100β)、神经元特异性烯醇化酶(NSE)水平与术后谵妄(POD)的相关性。方法选择择期行全髋置换术的老年患者(均合并陈旧性脑梗死),根据患者术后72 h内是否发生谵妄分为谵妄组(D组,n=31)和非谵妄组(C组,n=47)。患者均在腰硬联合麻醉下进行手术,术中间隔5 min记录两组患者平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))、rScO_(2)及MAP、rScO_(2)的最低值。计算平均D_(p-c)(平均SpO_(2)-平均rScO_(2))及最高D_(p-c)(平均SpO_(2)-最低rScO_(2))。记录两组rScO_(2)下降>20%或rScO_(2)值<50%持续时间>5 min的例数。分别于麻醉前(T_(0))、术毕(T_(1))、术后24 h(T_(2))和术后72 h(T_(3))抽取静脉血3 mL,采用酶联免疫吸附试验测定S-100β和NSE的水平。结果与C组比较,D组MAP、rScO_(2)最低值下降,D_(p-c)最高值上升,rScO_(2)下降>20%或rScO_(2)值<50%且持续时间>5 min的例数增加,S-100β和NSE水平在T_(1)~T_(3)均升高(P<0.01)。与T_(0)比较,两组S-100β和NSE水平在T_(1)~T_(3)均升高(P<0.01)。与T_(1)比较,两组S-100β和NSE水平在T_(2)、T_(3)均升高(P<0.01)。与T_(2)比较,两组S-100β和NSE水平在T_(3)均升高(P<0.01)。多因素logistic回归分析结果显示,MAP及rScO_(2)最低值、rScO_(2)较基础值下降>20%持续时间>5 min,以及术后72 h血清S-100β和NSE水平升高是POD发生的危险因素(P<0.01)。结论低MAP、低rScO_(2)、rScO_(2)较基础值下降20%持续时间>5 min及术后72 h血清S-100β、NSE水平升高是合并陈旧性脑梗死老年患者术后发生POD的危险因素。Objective To investigate the correlation between intraoperative regional cerebral oxygen saturation(rScO_(2))and central nervous injury marker S-100β,NSE levels and postoperative delirium(POD)in elderly patients with old cerebral infarction.Methods A total of 80 elderly patients patients undergoing elective total hip arthroplasty were selected.All patients were combined with old cerebral infarction,and two cases were excluded.According to whether delirium occurred within 72 hours after operation,the patients were divided into the delirium group(group D,n=31)and the non-delirium group(group C,n=47).All patients underwent surgery under combined spinal epidural anesthesia.Mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2)),rScO_(2),and the lowest values of MAP and rScO_(2) were recorded every five min during the operation.The mean DP-C(mean SpO_(2)-mean rScO_(2))and the highest DP-C(mean SpO_(2)-lowest rScO_(2))were calculated.The number of cases with rScO_(2) decreased by 20% or rScO_(2) value decreased by five min was recorded in the two groups.Venous blood three ml was collected before anesthesia(T_(0)),at the end of operation(T_(1)),24 h after operation(T_(2))and 72 h after operation(T_(3)).The levels of S-100βand NSE were measured by enzyme-linked immunosorbent assay.Results Compared with the group C,the lowest values of MAP and rScO_(2) in the group D decreased,the highest value of D_(p-c) increased,the number of cases with rScO_(2) decreased>20%or rScO_(2) value for five min increased,and S-100βand NSE increased at T_(1)-T_(3)(P<0.01).Compared with T_(0),S-100βand NSE increased T_(1)-T_(3) in both groups(P<0.01).Compared with T_(1),S-100βand NSE increased at T_(2) and T_(3) in both groups(P<0.01).Compared with T_(2),S-100βand NSE increased at T_(3) in both groups(P<0.01).Multivariate logistic regression analysis showed that the lowest value of MAP and rScO_(2),the decrease of rScO_(2) compared with the basic value>20%duration>5 min,and the increase of serum S-100βand NSE levels at 72 hours aft

关 键 词：谵妄 关节成形术 置换 髋 脑梗死 老年人 

分 类 号：R614.41[医药卫生—麻醉学]