| 陈娇,张萌,王爽,昝望,孟香弟,孙斌.老年患者肝切除术后谵妄的危险因素分析[J].中华老年多器官疾病杂志,2023,22(1):40~46 |
| 老年患者肝切除术后谵妄的危险因素分析 |
| Risk factors of postoperative delirium in elderly patients after hepatectomy |
| 投稿时间：2022-08-18 |
| DOI：10.11915/j.issn.1671-5403.2023.01.008 |
| 中文关键词: 老年人 肝切除术 术后谵妄 危险因素 |
| 英文关键词:aged hepatectomy postoperative delirium risk factors This work was supported by the Youth Medical Science and Technology Innovation Project of Xuzhou Municipal Health Commission |
| 基金项目:徐州市卫生健康委青年医学科技创新项目(XWKYHT20210591)；徐州市科技计划项目(KC22174) |
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| 中文摘要: |
| 目的 探讨老年患者肝切除术后谵妄(POD)的危险因素及对预后的影响。方法 回顾性分析2018年1月至2022年1月于徐州市中心医院全身麻醉下行肝切除术的314例老年患者的临床资料,根据是否发生POD将患者分为POD组(66例)和非POD组(248例)。采用SPSS软件(美国 Version 26)与R软件(美国Version 4.1.2)进行数据分析及绘图。根据数据类型,分别采用t检验、秩和检验、χ2检验、Fisher确切概率法或Wilcoxon秩和检验进行组间比较。采用单因素分析方法和多因素logistic回归方法分析老年患者肝切除术后POD发生的独立危险因素。结果 314例老年肝切除患者中,21.0%(66/314)发生POD。高龄(OR=1.167,95%CI 1.058~1.287；P<0.001)、体质量指数<18.5kg/m2(OR=2.115,95%CI 1.124~3.980；P=0.018)、术前低简易智力状态检查量表评分(OR=1.096,95%CI 1.047~1.148；P=0.021)、术前高查尔森合并症指数得分(OR=1.458,95%CI 1.132~1.878；P=0.007)、手术时间长(OR=1.043,95%CI 1.025~1.061；P=0.010)、术后入重症监护室(OR=2.481,95%CI 1.554~3.961；P<0.001),术后24h视觉模拟评分高(OR=1.038,95%CI 1.017~1.059；P=0.014)是老年肝切除患者POD的独立危险因素。该多因素logistic回归模型对POD有良好的区分能力(曲线下面积=0.865,95%CI 0.795~0.936),以及较高的拟合程度(Hosmer-Lemeshow拟合优度检验,χ2=5.199,P=0.804)。结论 外科医师与麻醉医师可通过术前评估及早识别存在POD风险的老年患者,改善术前状态,优化围术期管理,从而降低老年肝切除患者POD的发生率。 |
| 英文摘要: |
| Objective To investigate the risk factors and prognostic impact of postoperative delirium (POD) in elderly patients after hepatectomy. Methods A retrospective observational study was conductd on 314 elderly patients who underwent hepatectomy under general anesthesia in Xuzhou Central Hospital from January 2018 to January 2022. According to whether the patients had POD or not, the patients were divided into POD group (n=66) and non-POD group (n=248). SPSS software Version 26 and R software Version 4.1.2 were used for data analysis and graphing. Depending on data types, student′s t test, Rank sum test, Chi-square test, Fisher′s exact test or Wilcoxon rank sum test was employed for intergroup comparison. Univariate analysis and multivariate logistic regression were applied to analyze the independent risk factors of POD in elderly patients after hepatectomy. Results Among the 314 enrolled elderly patients, 66 (21.0%) developed POD. Advanced age (OR=1.167,95%CI 1.058-1.287; P<0.001), body mass index<18.5 kg/m2(OR=2.115,95%CI 1.124-3.980; P=0.018), lower preoperative mini-mental state examination score (OR=1.096,95%CI 1.047-1.148; P=0.021), higher preoperative Charlson comorbidity index (OR=1.458,95%CI 1.132-1.878; P=0.007), longer operation time (OR=1.043,95%CI 1.025-1.061; P=0.010), intensive care unit admission after operation (OR=2.481,95%CI 1.554-3.961; P<0.001), higher postoperative 24 h visual analogue scale score (OR=1.038,95%CI 1.017-1.059; P=0.014) were independent risk factors for POD in elderly patients after hepatectomy. After calculation, multivariate logistic regression model has good discriminative ability for postoperative POD (area under curve=0.865,95%CI 0.795-0.936) and has a high degree of fit (Hosmer-Lemeshow goodness of fit test, χ2=5.199, P=0.804). Conclusion Surgeons and anesthesiologists can identify elderly patients with high risk of POD through preoperative assessment as early as possible. Improvement of preoperative status and optimization of perioperative management can reduce the incidence of POD in elderly patients after hepatectomy. |
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