腹部手术患者术后谵妄发病高危因素研究  

Study on high-risk factors for postoperative delirium in patients after abdominal surgery

作　　者：石磊[1] 海峰[1] 贾艳红[2] 陆赬阳 王伟[1] 王小鹏 张东明[1,3] SHI Lei;HAI Feng;JIA Yanhong;LU Chengyang;WANG Wei;WANG Xiaopeng;ZHANG Dongming(Department of General Surgery,Baotou Central Hospital,Baotou,Inner Mongolia,014040,China;Department of Neurology,Baotou Central Hospital,Baotou,Inner Mongolia,014040,China;Department of General Surgery,Central Clinical Medical College,Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou,Inner Mongolia,014040,China)

机构地区：[1]包头市中心医院普通外科,内蒙古包头014040 [2]包头市中心医院神经内科,内蒙古包头014040 [3]内蒙古科技大学包头医学院中心临床医学院普通外科,内蒙古包头014040

出　　处：《现代医药卫生》2024年第23期4007-4012,共6页Journal of Modern Medicine & Health

基　　金：内蒙古医科大学联合项目(YKD2021LH084)。

摘　　要：目的研究围手术期炎症因子水平与腹部手术患者发生术后谵妄(POD)的关系及发生POD的高危因素,为预防POD的发生提供帮助。方法选取2021年11月至2022年10月包头市中心医院收治的接受腹部手术后患者157例,按纳入/排除标准筛选出符合入组条件患者148例,采用谵妄评定方法结合患者病情、意识变化情况按患者是否发生POD分为POD组(43例)和非POD组(105例)。收集2组患者一般资料,包括年龄、体重指数、住院时间等,结合围手术期降钙素原(PCT)、C反应蛋白、血磷、白细胞、中性粒细胞百分比、血红蛋白(Hb)、血浆清蛋白水平分析2组患者发生POD的差异,筛选发生POD的危险因素。结果148例患者中术后发生POD 43例(29.05%)。2组患者年龄、体重指数、住院费用,以及PCT、C反应蛋白、血浆清蛋白、血磷、中性粒细胞百分比、Hb水平比较,差异均有统计学意义(P<0.05)。PCT是发生POD的危险因素,血磷、Hb是发生POD的保护因素[优势比=1.124、0.001、0.963,95%可信区间(95%CI)1.022~1.238、0.000~0.038、0.933~0.994,P=0.017、<0.001、0.021]。检测PCT、血磷、Hb诊断POD的AUC分别为0.904、0.821、0.654,灵敏度分别为0.833、0.857、0.907,特异度分别为0.888、0.771、0.376,截断值分别为2.95μg/L、0.88 mmol/L、134 g/L(95%CI 0.840~0.949、0.746~0.881、0.568~0.733,P<0.001、<0.001、0.002);logistic逐步回归模型的AUC为0.922,灵敏度为0.829,特异度为0.886(95%CI 0.859~0.963,P<0.001)。结论PCT是发生POD的危险因素,血磷、Hb是发生POD的保护因素,PCT水平越高,血磷、Hb水平越低术后发生谵妄的可能性越大。Objective To investigate the relationship between perioperative inflammatory cytokine levels and the occurrence of postoperative delirium(POD)in patients undergoing abdominal surgery,as well as the high-risk factors for POD,to provide assistance for the prevention of POD.Methods A total of 157 patients who underwent abdominal surgery at Baotou Central Hospital from November 2021 to October 2022 were selected,and 148 patients who met the inclusion/exclusion criteria were screened out.Based on the delirium assessment method,combined with the patients'condition and changes in consciousness,they were divided into POD group(43 patients)and non-POD group(105 patients)according to whether they developed POD.General information of the two groups was collected,including age,body mass index,length of hospital stay,etc.Differences in POD occurrence between the two groups were analyzed in combination with perioperative levels of procalcitonin(PCT),C-reactive protein,blood phosphorus,white blood cells,neutrophil percentage,hemoglobin(Hb),and plasma albumin,and risk factors for POD were screened.Results Among the 148 patients,43 developed POD postoperatively,with an incidence rate of 29.05%.Statistically significant differences were observed between the two groups in terms of age,body mass index,hospitalization costs,and PCT,C-reactive protein,plasma albumin,blood phosphorus,neutrophil percentage,and Hb levels(P<0.05).PCT was identified as a risk factor for POD,while blood phosphorus and Hb were protective factors against POD[odds ratios=1.124,0.001,0.963;95%confidence intervals(95%CI)=1.022-1.238,0.000-0.038,0.933-0.994;P=0.017,<0.001,0.021].The areas under the curve(AUC)for diagnosing POD using PCT,blood phosphorus,and Hb were 0.904,0.821,and 0.654,respectively,with sensitivities of 0.833,0.857,and 0.907,and specificities of 0.888,0.771,and 0.376,respectively.The cutoff values were 2.95μg/L,0.88 mmol/L,and 134 g/L,respectively(95%CI=0.840-0.949,0.746-0.881,0.568-0.733;P<0.001,<0.001,0.002).The AUC of the logistic stepwise r

关 键 词：腹部手术 手术后并发症 谵妄 危险因素 

分 类 号：R656[医药卫生—外科学]