术前睡眠质量与老年胸科手术患者术后谵妄的相关性研究  

Correlation between preoperative sleep quality and postoperative delirium in elderly patients undergoing thoracic surgery

作　　者：刁萌萌 王涵 张书芮 焦皓 Diao Mengmeng;Wang Han;Zhang Shurui;Jiao Hao(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,the Afiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]徐州医科大学附属医院麻醉科,徐州221002

出　　处：《国际麻醉学与复苏杂志》2025年第3期273-279,共7页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨术前睡眠质量对老年胸科手术患者术后谵妄(POD)的影响以及与POD发生相关的危险因素。方法纳入2022年7月至2022年12月在徐州医科大学附属医院择期行胸科手术的60岁以上患者,术前1 d根据匹兹堡睡眠质量指数(PSQI)评分将患者分为睡眠正常组(H组,PSQI<5分,102例)和睡眠障碍组(L组,PSQI≥5分,101例)。两组均采用常规麻醉管理,术后使用患者自控静脉镇痛泵。记录两组患者一般情况[年龄、性别、体重指数、既往疾病史、手术史、术前血红蛋白)和手术资料(手术时间、失血量、输血量、术中低血压和低氧血症发生率、单肺通气30 min时动脉血氧分压(PaO_(2))],术后5 d内POD发生率,POD持续时间,术后拔管时间,PACU停留时间,麻醉药物(丙泊酚、瑞芬太尼)、血管活性药物(去氧肾上腺素、麻黄碱)及术后补救镇痛药物用量,术后24 h(T1)、术后48 h(T2)时改良15项恢复质量(QoR-15)评分,拔管15~30 min(T0)和T1、T2时视觉模拟评分法(VAS)疼痛评分,术后住院时长,术后30 d内再次住院比例及不良反应发生情况。根据患者是否发生POD分为POD组(P组,31例)与非POD组(NP组,172例),比较P组和NP组以上各指标情况。采用多因素logistic回归分析老年患者接受胸科手术后发生POD的影响因素,根据分析结果构建列线图预测模型,应用受试者操作特征(ROC)曲线下面积检验模型预测效果。结果H组和L组患者一般情况和手术资料差异无统计学意义(均P>0.05)。与H组比较,L组患者POD发生率较高,但差异无统计学意义(P>0.05);POD持续时间较长(P<0.05)。H组和L组患者麻醉药物、血管活性药物及术后补救镇痛药物用量,术后拔管时间,PACU停留时间,术后住院时长,术后30 d内再次入院比例及不良反应等发生率差异均无统计学意义(均P>0.05)。T0、T1时L组患者VAS疼痛评分高于H组(均P<0.05),T2时H组和L组患者VAS疼痛评分差异无统计学意义(P>0.05)Objective To explore the effect of preoperative sleep quality on postoperative delirium(POD)in elderly patients undergoing thoracic surgery and identify POD-related risk factors.Methods Patients aged over 60,who underwent elective thoracic surgery at the Affiliated Hospital of Xuzhou Medical University from July 2022 to December 2022,were included.One day before surgery,based on the Pittsburgh Sleep Quality Index(PSQI),the patients were divided into two groups:a normal sleep group(group H,PSQI<5,n=102)and a sleep disorders group(group L,PSQI≥5,n=101).Both groups received routine anesthesia management and postoperative patient-controlled intravenous analgesia.Their general information(including age,sex,body mass index,medical history,surgical history,and preoperative hemoglobin)and surgical data[including surgical time,blood loss,blood transfusion volume,intraoperative hypotension and hypoxemia incidences,and arterial partial pressure of oxygen(PaO_(2))at single-lung ventilation for 30 min]were recorded.Furthermore,the incidence of POD within 5 days following surgery,POD duration,time to extubation,and the length of post-anesthesia care unit(PACU)stay,as well as the dosage of anesthetics(propofol and remifentanil),vasopressors(norepinephrine and ephedrine),and postoperative rescue analgesics were recorded.The modified Quality of Recovery Scale-15(QoR-15)scores were assessed 24 h post-surgery(T1)and 48 h post-surgery(T2),while Visual Analog Scale(VAS)scores were measured at extubation 15‒30 min(T0),T1,and T2.The length of hospitalization stay,the percentage of readmission within 30 days following surgery,and the incidence of adverse reactions were also recorded.According to the presence of POD,the patients were divided into two groups:a POD group(group P,n=31)and a non-POD group(group NP,n=172)and their indicators were compared.Then,multivariate logistic regression analysis was conducted to identify independent risk factors for POD in elderly patients undergoing thoracic surgery.Based on the results,a nomogram

关 键 词：睡眠障碍 睡眠质量 术后谵妄 老年患者 胸科手术 

分 类 号：R614[医药卫生—麻醉学]