脊柱外科手术患者术后谵妄的预警因素及临床防治对策  

Early Warning Factors of Postoperative Delirium in Patients Undergoing Spinal Surgery and Its Prevention and Intervention Measures

作　　者：徐静宜[1] 李玉伟[1] 温艳[2] 袁琳涵 杨宇卓 潘文静 李方 XU Jingyi;LI Yuwei;WEN Yan;YUAN Linhan;YANG Yuzhuo;PAN Wenjing;LI Fang(Spinal Surgery,Luohe Central Hospital/the First People's Hospital of Luohe,Luohe 462005,China;Nursing Department,Luohe Central Hospital/the First People's Hospital of Luohe,Luohe 462005,China)

机构地区：[1]漯河市中心医院/漯河市第一人民医院脊柱外科,河南漯河462005 [2]漯河市中心医院/漯河市第一人民医院护理部,河南漯河462005

出　　处：《河南医学研究》2025年第2期249-252,共4页Henan Medical Research

摘　　要：目的探讨脊柱外科手术患者术后发生谵妄的预警因素及其预防干预对策。方法回顾性分析2022年3月至2023年3月漯河市中心医院收治315例脊柱外科手术患者的临床资料,根据所选患者术后是否发生谵妄将其分为谵妄组(44例)和无谵妄组(271例)。比较两组临床资料,并采用多因素logistic回归分析法分析脊柱外科手术患者术后发生谵妄的预警因素。结果谵妄组年龄大于无谵妄组,体重指数(BMI)高于无谵妄组,应用止痛泵、有脑卒中疾病史、慢性阻塞性肺疾病史、手术部位为颈椎的患者占比高于无谵妄组,术中低血压次数多于无谵妄组,术后全血血红蛋白(Hb)水平低于无谵妄组(P<0.05)。多因素logistic回归分析结果显示,高龄、有脑卒中疾病史、手术部位为颈椎、术中低血压次数多、术后全血Hb水平低是脊柱外科手术患者术后发生谵妄的独立危险因素(OR=2.683、2.151、2.683、1.496、3.425,P<0.05)。结论高龄、有脑卒中疾病史、手术部位为颈椎、术中低血压次数多、术后全血Hb水平低是脊柱外科手术患者术后发生谵妄的独立危险因素,临床可据此给予高危患者相关的治疗或干预措施,以减少术后发生谵妄。Objective To investigate the warning factors and clinical prevention and treatment strategies for postoperative delirium in patients undergoing spinal surgery.Methods The clinical data of 315 patients undergoing spinal surgery admitted to Luohe Central Hospital from March 2022 to March 2023 were retrospectively analyzed.According to whether postoperative delirium occurred,the selected patients were divided into the delirium group(44 cases)and the delirium free group(271 cases).The clinical data of the two groups were compared,and the early warning factors of postoperative delirium in patients undergoing spinal surgery were analyzed by multivariate logistic regression analysis.Results The age of the delirium group was older than that of the delirium free group,the body mass index(BMI)was higher than that of the delirium free group,and the proportion of patients with analgesic pump,history of stroke,history of chronic obstructive pulmonary disease and surgical site of cervical spine were higher than those of the delirium free group.The frequency of intraoperative hypotension was more than that of the delirium free group.The level of whole blood hemoglobin(Hb)after operation was lower than that in the delirious free group(P<0.05).Multivariate logistic regression analysis showed that old age,history of stroke,cervical spine location,more times of intraoperative hypotension,and low level of whole blood Hb were independent risk factors for postoperative delirium in patients undergoing spinal surgery(OR=2.683,2.151,2.683,1.496,3.425,P<0.05).Conclusion Older age,history of stroke,cervical vertebra as the surgical site,more times of intraoperative hypotension,and low level of whole blood Hb after spinal surgery were independent risk factors for postoperative delirium in patients undergoing spinal surgery.Therefore,relevant treatment or intervention measures could be given to high-risk patients to reduce postoperative delirium.

关 键 词：术后谵妄 脊柱外科 预警因素 

分 类 号：R681.5[医药卫生—骨科学]