老年患者术后谵妄与围术期炎症因子变化及相关因素的关系  

The relationship between postoperative delirium in elderly patients and changes in perioperative inflammatory factors and related factors

作　　者：姚毅真 唐俊 郑钰琪 王芳 李妍妍 YAO Yizhen;TANG Jun;ZHENG Yuqi;WANG Fang;LI Yanyan(Department of Anesthesiology,Shanghai Fifth People's Hospital,Fudan University,Shanghai 200240)

机构地区：[1]复旦大学附属上海市第五人民医院麻醉科,上海200240

出　　处：《湖南师范大学学报(医学版)》2024年第5期111-115,共5页Journal of Hunan Normal University(Medical Sciences)

基　　金：上海市闵行区自然科学研究课题“老年患者术后谵妄与围手术期炎症因此变化的相互关系”(2023MHZ060)

摘　　要：目的:探讨老年患者术后谵妄与围术期炎症因子变化及相关因素的关系。方法:收集本院2023年8月—2024年5月间行择期手术的老年患者260例。采用随机数字法分为全麻组(G组)和区域阻滞(L组),各130例。比较两组患者术后谵妄发生情况及血清白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、中枢神经特异蛋白(S100-β)变化,应用Logistic风险回归模型分析影响术后谵妄的单(P<0.05)因素及多因素。结果:G组患者术后谵妄共31例,发生率为23.85%,高于L组(17例,13.08%),差异有统计学意义(P<0.05);两组术后3d血清IL-6、TNF-α及S100-β水平均高于术前,但两组术后3d血清IL-6、TNF-α及S100-β水平组间比较,差异无统计学意义;术后谵妄患者术前MMSE评分低于无谵妄患者,ASA分级、手术时间、术后VAS评分、IL-6、TNF-α及S100-β水平和高龄占比均高于或长于术后无谵妄患者;Logistic单因素分析结果:ASA分级、术前MMSE评分、手术时间、术后IL-6、TNF-α、S100-β、麻醉方式、高龄与术后谵妄有关;Logistic多因素分析结果:麻醉方式(全麻)、术前MMSE评分、术后IL-6、TNF-α及S100-β、高龄为术后谵妄的危险因素。结论:老年患者术后谵妄与麻醉方式、术前MMSE评分、术后血清IL-6、TNF-α及S100-β、高龄等有关,通过监测上述因素,可为术后谵妄的防治提供参考。Objective To investigate the relationship between postoperative delirium and perioperative inflammatory factors in elderly patients.Methods 260 elderly patients undergoing elective surgery in our hospital from August 2023 to May 2024 were collected.They were randomly divided into general anesthesia group(group G)and regional anesthesia group(group L),130 cases in each group.The incidence of postoperative delirium,serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and central nervous system specific protein(S100-β)were compared between the two groups;Logistic regression model was used to analyze the univariate and multivariate factors affecting postoperative delirium.Results The incidence of postoperative delirium in group G was 23.84%,which was higher than that in group L(17 cases,13.08%),and the difference was statistically significant;Serum IL-6,TNF-αand S100-β3d after operation in the two groups were significantly higher than those before operation;There was no significant difference in IL-6,TNF-αand S100-β3d after operation between the two groups;The preoperative MMSE score of patients with postoperative delirium was lower than that of patients without delirium,ASA grade,operation time,postoperative VAS score,IL-6,TNF-αAnd S100-β,proportion of elderly people were higher or longer than those in patients without delirium after operation;Logistic univariate analysis results:ASA classification,preoperative MMSE score,operation time,postoperative IL-6,TNF-α,S100-β,Anesthesia method,advanced age was related to postoperative delirium;Logistic multivariate analysis results:anesthesia mode(general anesthesia),preoperative MMSE score,postoperative IL-6,TNF-αAnd S100-βIt was a risk factor for postoperative delirium.Conclusion Postoperative delirium in elderly patients and anesthesia methods,preoperative MMSE score,postoperative serum IL-6,TNF-αAnd S100-β,advanced age was monitoring the above factors can provide reference for the prevention and treatment of postoperative delirium.

关 键 词：老年 术后谵妄 白细胞介素-6 肿瘤坏死因子Α 中枢神经特异蛋白 相关性 

分 类 号：R61[医药卫生—外科学]