| 老年患者脊柱手术术后谵妄危险因素分析的回顾性研究 |
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投稿时间：2018-12-24
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| 作者 | Author | 单位 | Address | E-Mail |
| 崔小平 |
CUI Xiao-ping |
山西省人民医院骨科, 山西 太原 030012 |
Department of Orthopaedics, People's Hospital of Shanxi Provine, Taiyuan 030012, Shanxi, China |
fsyycxp@163.com |
| 荆志振 |
JING Zhi-zhen |
山西省人民医院骨科, 山西 太原 030012 |
Department of Orthopaedics, People's Hospital of Shanxi Provine, Taiyuan 030012, Shanxi, China |
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| 宋洁富 |
SONG Jie-fu |
山西省人民医院骨科, 山西 太原 030012 |
Department of Orthopaedics, People's Hospital of Shanxi Provine, Taiyuan 030012, Shanxi, China |
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| 张鹏 |
ZHANG Peng |
山西省人民医院骨科, 山西 太原 030012 |
Department of Orthopaedics, People's Hospital of Shanxi Provine, Taiyuan 030012, Shanxi, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第6期，第549-554页 |
| DOI：10.3969/j.issn.1003-0034.2019.06.013 |
| 基金项目: |
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中文摘要:
目的：探讨老年患者脊柱手术术后谵妄的发生率及相关危险因素。
方法：采用回顾性分析2016年1月至2018年11月收治的老年脊柱手术病例436例，根据术后是否发生谵妄分为谵妄组和非谵妄组。记录患者的性别、年龄、身体质量指数，糖尿病史，冠心病史，慢性阻塞性肺疾病史，术前白细胞计数，术前红细胞比容，术前血红蛋白水平，手术方式，手术时间，麻醉时间，美国麻醉医师协会（ASA）评分，心功能分级，术中失血量，术中输血量，术中芬太尼、异丙酚和地佐辛的用量，术后白细胞计数，术后红细胞比容，术后血红蛋白水平，术后电解质（钠离子、钾离子），采用单因素Logistic回归分析有统计学意义的危险因素后进行多元Logistic回归分析进一步探讨独立危险因素。
结果：纳入436例中112例老年患者术后出现谵妄，发生率25.68%。谵妄组与非谵妄组在年龄、术前白细胞计数、术前红细胞比容、术后红细胞比容、术后血红蛋白水平、术后钠离子浓度、麻醉时间、ASA评分、心功能评分、术中失血量、术后地佐辛使用量、糖尿病史、冠心病史、慢性阻塞性肺疾病史方面差异有统计学意义（P<0.05），通过多因素Logistic回归分析显示年龄、ASA评分、术后地佐辛量、慢性阻塞性肺疾病史是老年患者脊柱手术术后谵妄发生的独立危险因素。
结论：患者高龄>72岁、ASA评分>2分、地佐辛镇痛药物的使用以及患者合并慢性阻塞性肺疾病史是术后谵妄发生的独立危险因素。 |
| 【关键词】脊柱手术 谵妄 危险因素 老年人 |
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| A retrospective study on risk factors associated with postoperative delirium in elderly patients with spinal operation |
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ABSTRACT
Objective:To investigate the incidence and risk factors of delirium after spinal surgery in elderly patients.
Methods:A retrospective analysis was performed on 436 patients with spinal surgery from January 2016 to November 2018. According to delirium occurrancy after the operation,436 cases were divided into two groups:delirium group and non-delirium group. Body mass index(BMI),history of diabetes,history of coronary heart disease,history of chronic obstructive pulmonary disease (COPD),preoperative white blood cell count,preoperative erythrocyte volume,preoperative hemoglobin level,operation mode,operation time,anesthesia time,American Association of Anesthesiologists(ANA)(ASA) score,cardiac function grading(NYHA),intraoperative blood loss,intraoperative blood transfusion,intraoperative fentanyl,propofol and Dizocine dosage,postoperative white blood cell count,postoperative erythrocyte volume,postoperative hemoglobin level,postoperative electrolytes (sodium,potassium) and univariate logistic regression analysis were used to analyze the risk factors. The independent risk factors were further investigated by multivariate Logistic regression analysis.
Results:Among 436 cases,112 elderly patients had postoperative delirium,the incidence of delirium was about 25.68%. The age,preoperative leukocyte count,erythrocyte specific volume,postoperative hemoglobin level in delirium group and non-delirium group were measured. There were significant differences in the postoperative sodium concentration,anesthesia time,ASA score,cardiac function grading,blood loss during operation,postoperative use of Dizocine,history of diabetes,history of coronary heart disease and history of COPD (P<0.05). Multivariate logistic regression analysis showed that the age,ASA score,postoperative Dizocine volume,and COPD history were independent risk factors for the occurrence of delirium after spinal surgery in elderly patients.
Conclusion:The elderly patients over 72 years old,the ASA score>2,the use of Dizocine analgesic and the patients with COPD are the independent risk factors of postoperative delirium. |
| KEY WORDS Spinal surgery Delirium Risk factors Elderly |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 崔小平,荆志振,宋洁富,张鹏.老年患者脊柱手术术后谵妄危险因素分析的回顾性研究[J].中国骨伤,2019,32(6):549~554 |
| 英文格式: | CUI Xiao-ping,JING Zhi-zhen,SONG Jie-fu,ZHANG Peng.A retrospective study on risk factors associated with postoperative delirium in elderly patients with spinal operation[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(6):549~554 |
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