老年患者术前睡眠质量与术后谵妄的关系  

Relationship between preoperative sleep quality and postoperative delirium in elderly patients

作　　者：王元龙 李燕玲[1] 化树慧 徐钐凌 孔荐 巩红岩 董瑞[1] 林亚男 李传 毕燕琳[1] 王彬[1] 林旭[1] Wang Yuanlong;Li Yanling;Hua Shuhui;Xu Shanling;Kong Jian;Gong Hongyan;Dong Rui;Lin Yanan;Li Chuan;Bi Yanlin;Wang Bin;Lin Xu(Department of Anesthesiology,Qingdao Municipal Hospital,Qingdao 266071,China;The Second Clinical Medical College of Binzhou Medical University,Yantai 264003,China;School of Anesthesiology,Shandong Second Medical University,Weifang 261053,China)

机构地区：[1]青岛市市立医院麻醉科,青岛266071 [2]滨州医学院第二临床医学院,烟台264003 [3]山东第二医科大学麻醉学院,潍坊261053

出　　处：《中华麻醉学杂志》2024年第11期1287-1292,共6页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(91849126)。

摘　　要：目的评价老年患者术前睡眠质量与术后谵妄(POD)的关系。方法选取2022年5月至2023年10月青岛市市立医院择期于脊椎-硬膜外麻醉下行膝/髋关节置换术患者389例,年龄65~90岁,性别不限,ASA分级Ⅰ或Ⅱ级。术前1 d应用匹兹堡睡眠质量指数(PSQI)量表对患者术前1个月内的睡眠质量进行评估。麻醉前于蛛网膜下腔抽取脑脊液(CSF)标本2 ml,采用ELISA法测定生物标志物[β淀粉样蛋白、总tau蛋白(t-tau)和磷酸化tau蛋白(p-tau)]的浓度。根据术后7 d内是否发生谵妄将患者分为POD组和非POD组。采用logistic回归筛选POD的危险因素,采用敏感性分析检验回归模型稳定性,使用中介模型检测CSF生物标志物在睡眠质量对POD影响中的中介效应;绘制受试者工作特征曲线并计算曲线下面积(AUC)评价术前睡眠质量和CSF生物标志物浓度预测POD发生的准确性。结果最终纳入279例,其中POD组33例,非POD组246例。logistic回归分析在校正了年龄、性别、BMI、教育年限、MMSE评分、VAS评分等多个混杂因素后的结果表明,术前1个月内睡眠时间缩短、使用催眠药物、日间功能障碍、CSF t-tau浓度升高、CSF p-tau浓度升高为POD的危险因素。中介效应结果显示,术前1个月内使用催眠药物和日间功能障碍对POD的影响部分由CSF p-tau浓度介导(中介比例分别为:10.6%和11.9%)。术前1个月内日间功能障碍、睡眠时间、使用催眠药物和CSF生物标志物浓度联合预测POD的AUC为0.979。结论老年患者术前1个月内睡眠时间缩短、使用催眠药物和日间功能障碍为POD的危险因素,且使用催眠药物、日间功能障碍与POD的关系部分由CSF p-tau介导。Objective To evaluate the relationship between the preoperative sleep quality and postoperative delirium(POD)in elderly patients.Methods Three hundred and eighty-nine patients of either sex,aged 65-90 yr,with American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ,who underwent elective knee/hip arthroplasty under combined spinal-epidural anesthesia in Qingdao Municipal Hospital from May 2022 to October 2023,were selected.The Pittsburgh Sleep Quality Index scale was applied at 1 day before surgery to assess the sleep quality within 1 month before surgery.The cerebrospinal fluid(CSF)specimens 2 ml were withdrawn from the subarachnoid space before anesthesia for determination of the concentrations of biomarkers(β-amyloid),total tau protein[t-tau],and phosphorylated tau protein[p-tau]by enzyme-linked immunosorbent assay.Patients were divided into POD group and non-POD group based on whether delirium occurred within 7 days after surgery.Logistic regression was used to identify the risk factors for POD,and the sensitivity analysis was used to test the stability of the regression models.The mediation model was used to examine whether CSF biomarkers mediated the link between sleep quality and POD.The accuracy of preoperative sleep quality and CSF biomarker concentrations in predicting the occurrence of POD was evaluated by plotting the receiver operating characteristic curve and calculating the area under the curve.Results Two hundred and seventy-nine patients were finally included,with 33 patients in POD group and 246 patients in non-POD group.The results of logistic regression analysis showed that shorter sleep duration,use of hypnotics,daytime dysfunction within 1 month before surgery,elevated t-tau concentrations in CSF,and elevated p-tau concentrations in CSF were risk factors for POD after adjusting for multiple confounding factors such as age,sex,body mass index,years of education,Mini-Mental State Examination score,and VAS score.The results of mediating effect showed that the effect of u

关 键 词：老年人 睡眠 谵妄 手术后并发症 

分 类 号：R614[医药卫生—麻醉学]