老年患者关节置换术中脑电图纺锤波缺失与苏醒期谵妄的关系  

Relationship between intraoperative EEG spindle loss and emergence delirium in elderly patients undergoing joint replacement surgery

作　　者：刘玉梅[1] 黄辉[1] 高洁[1] 禚艳丽 褚海辰[1] LIU Yumei;HUANG Hui;GAO Jie;ZHUO Yanli;CHU Haichen(Department of Anesthesiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266003

出　　处：《精准医学杂志》2024年第1期25-28,32,共5页Journal of Precision Medicine

基　　金：国家自然科学基金资助项目(8187050711)。

摘　　要：目的探讨老年患者关节置换术中脑电图纺锤波缺失与苏醒期谵妄(emergence delirium,ED)的关系,并进一步分析患者发生ED的独立危险因素。方法选取2020年11月-2021年2月于青岛大学附属医院在全身麻醉下行关节置换术的老年患者69例,记录患者术前、术中信息,以及术后麻醉苏醒后恢复室停留时间和术后谵妄发生率。根据患者术中脑电图是否存在纺锤波分为纺锤波组和缺失纺锤波组,分析术中脑电图纺锤波缺失与ED的关系。再根据患者术后是否发生ED分为ED组和非ED组,对两组患者的各项观察指标进行单因素分析,将单因素分析中P<0.05的因素以及以往研究报道的危险因素纳入多因素Logistic回归分析模型,分析患者ED发生的独立危险因素。结果单因素分析结果显示,缺失纺锤波组患者发生ED比例显著高于纺锤波组,差异有显著性(χ^(2)=11.189,P<0.05)。ED组和非ED组患者的年龄、性别、中风史和脑电图纺锤波缺失比例比较差异有显著性(t=-3.804,χ^(2)=4.071~11.189,P<0.05);多因素Logistic回归分析结果显示,年龄(OR=1.197,95%CI=1.066~1.344)和术中脑电图纺锤波缺失(OR=6.062,95%CI=1.384~26.543)是ED发生的独立危险因素。结论关节置换老年患者术中脑电图纺锤波缺失与ED的发生有关;术中脑电图纺锤波缺失、年龄是患者术后发生ED的独立危险因素,可能是预测ED发生的重要参考指标。Objective To investigate the relationship between intraoperative electroencephalographic(EEG)spindle loss and emergence delirium(ED)in elderly patients undergoing joint replacement surgery,and to further analyze the independent risk factors for ED.Methods A total of 69 elderly patients who underwent joint replacement surgery under general anesthesia in The Affiliated Hospital of Qingdao University from November 2020 to February 2021 were selected.Preoperative and intraoperative indicators,as well as length of stay in postanesthesia care unit and postoperative delirium incidence,were recorded.According to the presence or absence of EEG spindle waves,the patients were divided into spindle group and spindle loss group,and the relationship between intraoperative EEG spindle loss and ED was analyzed.The patients were then divided into ED group and non-ED group according to the presence or absence of ED after surgery.A univariate analysis was performed on various indicators of patients in the two groups.Factors with P<0.05 in univariate analysis and risk factors reported in previous studies were included in a multivariate logistic regression analysis model to identify independent risk factors for ED.Results The results of univariate analysis showed that the proportion of ED in the spindle loss group was significantly higher than that in the spindle group(χ^(2)=11.189,P<0.05).There were significant differences in age,sex,stroke history,and the proportion of EEG spindle loss between the ED group and the non-ED group(t=-3.804,χ^(2)=4.071-11.189,P<0.05).The multivariate logistic regression analysis showed that age(OR=1.197,95%CI=1.066-1.344)and intraoperative EEG spindle loss(OR=6.062,95%CI=1.384-26.543)were indepen-dent risk factors for ED.Conclusion In elderly patients undergoing joint replacement surgery under general anesthesia,intrao-perative EEG spindle loss is associated with the occurrence of ED.Intraoperative EEG spindle loss and age are independent risk factors for ED and may be important reference indicators f

关 键 词：关节成形术 置换 苏醒谵妄 纺锤波 脑电描记术 麻醉 全身 危险因素 老年人 

分 类 号：R741.041[医药卫生—神经病学与精神病学]