非心脏手术老年患者术后谵妄及术后认知功能障碍相关危险因素研究

摘要

目的 筛选老年患者发生术后谵妄(postoperative delirium,POD)及术后认知功能障碍(postoperative cognitive dysfunction, POCD)的相关危险因素,以及探索POD与POCD之间的联系.方法 选取220例行择期非心脏手术患者,年龄≥60岁,美国麻醉医师协会(American Society of Anesthesiologists, ASA) I ～ Ⅲ级,于术前1 d以及术后第1、2、3、7天用意识混乱评估法对患者进行POD的诊断,于术前l d以及术后第7天对患者进行POCD神经心理量表测试,用于诊断POCD.分别根据患者POD和POCD患病与否将患者分为POD组和非POD组、POCD组和非POCD组,比较两组患者的围术期临床资料,采用向后逐步法引入备选危险因素进行Logistic回归分析,筛选可能引起POCD或POD的独立危险因素.按POD患病与否分组后统计两组患者POCD发生率差异,分析POD与POCD发生是否具有相关性.结果 术后患者POD发生率为12.8％,POCD发生率为44.1％.ASA分级高(Oβ =2.605,95％CI:1.160 ～ 3.067)、患者术后第1天视觉模拟疼痛评分(visual analogue scale, VAS)高(OR =2.061,95％ CI-1.024 ～2.549)是老年患者 POCD发生的危险因素.性别(男性)(OR=6.087,95％ CI: 1.685 ～ 14.893)、ASA分级高(OR =4.548,95％ CI:2.487 ～ 10.384)、低体质量指数(body mass index,BMI) (OR =0.750,95％ C/:0.601 ～0.939)和合并糖尿病(OR =4.673,95％ CI:1.209 ～8.674)是老年患者POD发生的危险因素.POD组的POCD发生率为80％,高于非POD组为38.8％ (P＜0.05).结论 ASA分级高、患者术后第1天VAS高是老年患者POCD发生的危险因素,男性、ASA分级高、低BMI和糖尿病是老年患者POD发生的危险因素,POD患者更容易发生POCD.%Objective To investigate the risk factors of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in elderly patients, and explore the relationship between POD and POCD. Methods Two hundreds and twenty ASAI-Ⅲ patients aged over or equal to 60 years old undergoing elective non-cardiac surgery were enrolled. Evaluate patients with the confusion assessment method (CAM) for diagnosis of POD on the day before and the 1st, 2nd, 3rd, 7th day after surgery. Also the neuropsychological test for diagnosis of POCD was evaluated on the day before and one week after surgery. According to whether with POD or POCD, the patients were divided respectively into two groups: POD group and non-POD group or POCD group and non-POCD group. Compare the perioperative clinical data between the two groups and binary Logistic regression analysis was used for definition the risk factors of POD and POCD. In addition, the patients were divided into two groups according to whether with POD to compare the rate of the incidence of POCD. Results The incidence of POD and POCD is respectively 12.8％ and 44.1％. High ASA classification (OR = 2.605, 95％ CI: 1.160-3.067) and high visual analogue scale(VAS) score of the first day after surgery (OR= 2.061 ,95％ CI: 1.024-2.549) are the risk factors of POCD in elderly patients. Gender (male) (OR = 6.087,95％ CI: 1.685-14.893), high ASA classification (OR=4.548, 95％ CI: 2.487-10.384), low body mass index(BMI) (OR=0.75, 95％ CI: 0.601-0.939) and diabetes(OR =4.673, 95％ CI: 1.209-8.674)are the risk factors of POD in elderly patients. The incidence of POCD in the POD group is 80％, which is much higher than the non-POD group (38.8％)(P＜0.05). Conclusion High ASA classification and high VAS score of the first day are the risk factors of POCD in elderly patients. Male, high ASA classification, low BMI and diabetes are the risk factors of POD in elderly patients. The patients who have developed POD are easier to surfer from POCD.