术前血浆纤维蛋白原与老年骨科手术病人术后谵妄的相关性研究  

Correlation between preoperative plasma fibrinogen and postoperative delirium in elderly patients undergoing orthopedic surgery

作　　者：柳权芳 段华玮 胡小义 纪木火 樊迪 LIU Quanfang;DUAN Huawei;HU Xiaoyi;JI Muhuo;FAN Di(Department of Anesthesiology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院麻醉科,江苏省南京市210011

出　　处：《实用老年医学》2024年第12期1220-1223,1228,共5页Practical Geriatrics

基　　金：国家自然科学基金资助项目(82172131)。

摘　　要：目的探讨术前血浆纤维蛋白原与老年骨科手术病人术后谵妄(POD)的相关性,及其对POD的预测价值。方法选取2021年2月至2023年8月在南京医科大学第二附属医院择期行骨科手术的440例老年病人为研究对象,收集病人临床资料。根据有无发生POD分为POD组与Non-POD组,探究纤维蛋白原与老年骨科手术病人POD的相关性及其对POD的预测价值。结果本研究有74例病人发生POD,发生率为16.82%。与Non-POD组相比,POD组年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、手术史比例、术中失血量,白细胞、CRP、纤维蛋白原、肌酐水平及凝血酶原时间明显增加(P<0.05),BMI、术前MMSE评分、血红蛋白及白蛋白水平明显降低(P<0.05)。Logistic回归分析结果显示,高ASA分级(OR=3.839,95%CI:1.613~9.140,P=0.002)、术前低MMSE评分(OR=0.895,95%CI:0.839~0.955,P=0.001)、高龄(OR=1.098,95%CI:1.041~1.159,P=0.001)及高纤维蛋白原水平(OR=1.695,95%CI:1.117~2.573,P=0.013)是POD发生的独立危险因素。年龄、术前MMSE、纤维蛋白原及ASA分级预测POD的AUC分别为0.819(0.762~0.875)、0.779(0.713~0.846)、0.737(0.671~0.803)和0.760(0.707~0.814)。联合以上4项指标预测POD的AUC为0.889(0.848~0.930),敏感度为82.40%,特异度为82.00%。结论POD病人术前血浆纤维蛋白原水平明显增高,可作为POD的预测标志物之一。Objective To explore the correlation between preoperative plasma fibrinogen and postoperative delirium(POD)in the elderly patients undergoing orthopedic surgery,and to explore the predictive value of preoperative plasma fibrinogen for POD.Methods A total of 440 elderly patients undergoing orthopedic surgery at the Second Affiliated Hospital of Nanjing Medical University from February 2021 to August 2023 were enrolled in this study.The clinical data were collected.According to the occurrence of POD,the patients were divided into POD group and Non-POD group.Logistic regression analysis and receiver operating characteristic(ROC)curve were used to analyze the correlation between preoperative plasma fibrinogen and POD and the predictive value of preoperative plasma fibrinogen for POD in the elderly patients undergoing orthopedic surgery.Results There were 74(16.82%)cases presenting with POD in this study.Compared with Non-POD group,the levels of age,American Society of Anesthesiologists(ASA)classification,surgical history,intraoperative blood loss,white blood cells,C-reactive protein,fibrinogen,creatinine and prothrombin time were significantly higher,while the levels of body mass index(BMI),preoperative Mini-Mental State Examination(MMSE)score,hemoglobin and albumin were significantly lower in POD group(P<0.05).Logistic regression analysis showed that ASA grade(OR=3.839,95%CI:1.613-9.140,P=0.002),preoperative MMSE(OR=0.895,95%CI:0.839-0.955,P=0.001),age(OR=1.098,95%CI:1.041-1.159,P=0.001)and fibrinogen(OR=1.695,95%CI:1.117-2.573,P=0.013)were the independent influencing factors of POD.ROC curve showed that the area under the curve(AUC)of age,preoperative MMSE,fibrinogen,and ASA classification predicting POD was 0.819(0.762-0.875),0.779(0.713-0.846),0.737(0.671-0.803),and 0.760(0.707-0.814),respectively.The AUC of the combination of four indicators in predicting POD was 0.889(0.848-0.930),with a sensitivity of 82.40%and a specificity of 82.00%.Conclusions Preoperative plasma fibrinogen is significantly increased in the

关 键 词：纤维蛋白原 老年人 骨科手术 术后谵妄 

分 类 号：R687.3[医药卫生—骨科学]